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Low-grade inflammation differentiates between symptoms of apathy and depression in community-dwelling older individuals

Published online by Cambridge University Press:  30 December 2014

Lisa S. M. Eurelings ,
Edo Richard ,
Piet Eikelenboom ,
Willem A. van Gool  and
Eric P. Moll van Charante
Lisa S. M. Eurelings*
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
Edo Richard
Affiliation:
Department of Neurology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, the Netherlands
Piet Eikelenboom
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands Department of Psychiatry, VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, the Netherlands GGZ inGeest, PO Box 74077, 1070 BB, Amsterdam, the Netherlands
Willem A. van Gool
Affiliation:
Department of Neurology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
Eric P. Moll van Charante
Affiliation:
Department of General Practice, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, the Netherlands
*
Correspondence should be addressed to: Lisa S. M. Eurelings, Academic Medical Center, department of Neurology, room H2-235, PO Box 22660, 1100 DD Amsterdam, the Netherlands. Phone: +31 20 5663446; Fax: +31 20 5669290. Email: l.s.eurelings@amc.nl.
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Abstract

Background:

Systemic low-grade inflammation has repeatedly been associated with depression in old age, but the relationship with apathy is less clear. The present study assessed whether C-reactive protein (CRP) is differentially associated with symptoms of apathy and depression.

Methods:

A population-based cohort study was carried-out. At baseline and after two and four years of follow-up, CRP levels were assessed and symptoms of apathy and depression were measured using the 15-item Geriatric Depression Scale. Logistic regression analysis was used to investigate the cross-sectional and longitudinal associations of CRP with symptoms of apathy and depression.

Results:

Two thousand forty-seven community-dwelling participants (70–78 years) without a history of cardiovascular disease or stroke were studied. A cross-sectional association was found between CRP and apathy symptoms at three time points (odds ratio (OR) per natural log unit increase in CRP: baseline visit = 1.40, 95% CI = 1.12–1.75; two-year follow-up visit = 1.62, 95% CI = 1.17–2.25; four-year follow-up visit = 1.51, 95% CI = 1.03–2.21). This did not change after adjustment for demographics and depressive symptoms, and was slightly attenuated after adjustment for cardiovascular risk factors. No cross-sectional association was found with depressive symptoms. Baseline CRP did not predict incident apathy or depressive symptoms during four years of follow-up.

Conclusions:

Increased CRP levels are associated with apathy symptoms but not with depressive symptoms. This suggests a differential effect of inflammation on apathy and depression. In older persons, symptoms of apathy may be a behavioral manifestation of concurrent low-grade inflammation.

Keywords

apathydepressioninflammationC-reactive proteincardiovascular disease
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 4 , April 2015 , pp. 639 - 647
Copyright
Copyright © International Psychogeriatric Association 2014 

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References

Allin, K. H. and Nordestgaard, B. G. (2011). Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Critical Reviews in Clinical Laboratory Sciences, 48, 155–170. doi: 10.3109/10408363.2011.599831.Google Scholar
Bisoendial, R. J., Boekholdt, S. M., Vergeer, M., Stroes, E. S. G. and Kastelein, J. J. P. (2010). C-reactive protein is a mediator of cardiovascular disease. European Heart Journal, 31, 2087–2091. doi:10.1093/eurheartj/ehq238.Google Scholar
Brodaty, H., Sachdev, P. S., Withall, A., Altendorf, A., Valenzuela, M. J. and Lorentz, L. (2005). Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke - the Sydney Stroke Study. Psychological Medicine, 35, 1707–1716. doi:10.1017/S0033291705006173.Google Scholar
Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W. and Kelley, K. W. (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. Nature Reviews Neuroscience, 9, 46–56. doi:10.1038/nrn2297.Google Scholar
Duivis, H. E., Vogelzangs, N., Kupper, N., de Jonge, P. and Penninx, B. W. J. H. (2013). Differential association of somatic and cognitive symptoms of depression and anxiety with inflammation: findings from the Netherlands study of depression and anxiety (NESDA). Psychoneuroendocrinology, 38, 1573–1585. doi: 10.1016/j.psyneuen.2013.01.002.Google Scholar
Eurelings, L. S. M., Jaccard, J., Moll van Charante, E. P., Ligthart, S. A., Van Gool, W. A. and Richard, E. (2014b).The mediating role of cardiovascular risk factors in the relationship between symptoms of apathy, depression, and incident cardiovascular disease in older individuals. Submitted.Google Scholar
Eurelings, L. S. M., Ligthart, S. A., Van Dalen, J. W., Moll Van Charante, E. P., Van Gool, W.A. and Richard, E. (2014a). Apathy is an independent risk factor for incident cardiovascular disease in the older individual: a population-based cohort study. International Journal of Geriatric Psychiatry, 29, 454–463. doi:10.1002/gps.4026.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi:10.1016/0022-3956(75)90026-6.Google Scholar
Fones, C. S. (1998). Distinguishing apathy syndromes from vascular depression. Archives of General Psychiatry, 55, 844–845. doi:10.1001/archpsyc.55.9.844.Google Scholar
Guimarães, H. C., Caramelli, P., de Paula França, E., Afonso, M. P. D., Fialho, P. P. A. and Teixeira, A. L. (2013). Serum levels of soluble TNF-α receptors but not BDNF are associated with apathy symptoms in mild Alzheimer's disease and amnestic mild cognitive impairment. Dementia e Neuropsychologia, 7, 298–303.CrossRefGoogle Scholar
Hall, J. R., Johnson, L. A., Vo, H. T., Barber, R. C., Winter, S. and O’Bryant, S. E. (2012). Biomarkers and depressive symptoms in older women with and without cognitive impairment. Journal of Behavioral and Brain Science, 2, 276–281. doi: 10.4236/jbbs.2012.22031.Google Scholar
Hall, J. R., Vo, H. T., Johnson, L. A., Winter, S., Barber, R. C. and O’Bryant, S. E. (2011). Biomarkers and depressive symptoms in a sample of cognitively intact and Alzheimer's Disease elderly males. Neuroscience & Medicine, 2, 306–312. doi: 10.4236/nm.2011.24040.CrossRefGoogle Scholar
Heringa, S. M. et al. (2014). Markers of low-grade inflammation and endothelial dysfunction are related to reduced information processing speed and executive functioning in an older population - the Hoorn Study. Psychoneuroendocrinology, 40, 108–118. doi: 10.1016/j.psyneuen.2013.11.011.Google Scholar
Hoth, K. F. et al. (2008). Elevated C-reactive protein is related to cognitive decline in older adults with cardiovascular disease. Journal of the American Geriatrics Society, 56, 1898–1903. doi: 10.1111/j.1532-5415.2008.01930.x.CrossRefGoogle ScholarPubMed
Howren, M. B., Lamkin, D. M. and Suls, J. (2009). Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosomatic Medicine, 71, 171–186. doi: 10.1097/PSY.0b013e3181907c1b Google Scholar
Inagaki, M. et al. (2013). Associations of interleukin-6 with vegetative but not affective depressive symptoms in terminally ill cancer patients. Supportive Care in Cancer, 21, 2097–2106. doi: 10.1007/s00520-013-1767-x.Google Scholar
Lesher, E. L. and Berryhill, J. S. (1994). Validation of the geriatric depression scale-short Form among inpatients. Journal of Clinical Psychology, 50, 256–260. doi: 10.1002/1097-4679(199403)50:2<256::AID-JCLP2270500218>3.0.CO;2-E.Google Scholar
Ligthart, S. A. et al. (2012). Association of vascular factors with apathy in community-dwelling elderly individuals. Archives of General Psychiatry, 69, 636–642. doi:10.1001/archgenpsychiatry.2011.1858.CrossRefGoogle ScholarPubMed
Lima, T. A. S. et al. (2014). C-reactive protein, APOE genotype and longitudinal cognitive change in an older population. Age and Ageing, 43, 289–292. doi: 10.1093/ageing/aft193.CrossRefGoogle Scholar
Luppa, M. et al. (2012). Age- and gender-specific prevalence of depression in latest-life–systematic review and meta-analysis. Journal of Affective Disorders, 136, 212–221. doi:10.1016/j.jad.2010.11.033.Google Scholar
Maas, D. W., Van der Mast, R. C. and de Craen, A. J. M. (2009). Increased C-reactive protein is not associated with apathy: the Leiden 85-Plus Study. International Journal of Geriatric Psychiatry, 24, 1177–1184. doi: 10.1002/gps.2242.Google Scholar
Marin, R. S., Firinciogullari, S. and Biedrzycki, R. C. (1993). The sources of convergence between measures of apathy and depression. Journal of Affective Disorders, 28, 7–14. doi: 10.1016/0165-0327(93)90072-R.CrossRefGoogle ScholarPubMed
Richard, E. et al. (2009). Prevention of dementia by intensive vascular care (PreDIVA): a cluster-randomized trial in progress. Alzheimer Disease and Associated Disorders, 23, 198–204. doi:10.1097/WAD.0b013e31819783a4.Google Scholar
Ridker, P. M. (2003). Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation, 107, 363–369. doi: 10.1161/01.CIR.0000053730.47739.3C.Google Scholar
Robert, P. et al. (2009). Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders. European Psychiatry, 24, 98–104. doi:10.1016/j.eurpsy.2008.09.001 Google Scholar
Valkanova, V., Ebmeier, K. P. and Allan, C. L. (2013). CRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. Journal of Affective Disorders, 150, 736–744. doi: 10.1016/j.jad.2013.06.004.CrossRefGoogle ScholarPubMed
Van der Mast, R. C. et al. (2008). Vascular disease and apathy in old age. The Leiden 85-Plus Study. International Journal of Geriatric Psychiatry, 23, 266–271. doi: 10.1002/gps.1872.Google Scholar
Van Reekum, R., Stuss, D. T. and Ostrander, L. (2005). Apathy: why care? The Journal of Neuropsychiatry and Clinical Neurosciences, 17, 7–19. doi:10.1176/appi.neuropsych.17.1.7.Google Scholar
Wilkins, V. M., Kiosses, D. and Ravdin, L. D. (2010). Late-life depression with comorbid cognitive impairment and disability: nonpharmacological interventions. Clinical Interventions in Aging, 5, 323–331. doi: 10.2147/CIA.S9088.Google Scholar
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