title: Structural MRI correlates of apathy symptoms in older persons without dementia: AGES-Reykjavik Study.
abstract: OBJECTIVE
  We aimed to investigate the relation between apathy symptoms and structural brain changes on MRI, including white matter lesions (WMLs) and atrophy, in a large cohort of older persons.
  
  
  METHODS
  Cross-sectional analyses are based on 4,354 persons without dementia (aged 76 ± 5 years) participating in the population-based Age, Gene/Environment Susceptibility-Reykjavik Study. Apathy symptoms were assessed with 3 items from the 15-item Geriatric Depression Scale. Brain volumes and total WML volume were estimated on 1.5-tesla MRI using an automated segmentation program; regional WML load was calculated using a semiquantitative scale. Regression analyses were adjusted for age, sex, education, intracranial volume, vascular risk factors, physical activity, brain infarcts, depressive symptoms, antidepressants, and cognitive status.
  
  
  RESULTS
  Compared to those with <2 apathy symptoms, participants with ≥ 2 apathy symptoms (49% of the cohort) had significantly smaller gray matter volumes (mean adjusted difference -3.6 mL, 95% confidence interval [CI] -6.2 to -1.0), particularly in the frontal and temporal lobes; smaller white matter volumes (mean adjusted difference -1.9 mL, 95% CI -3.6 to -0.3), mainly in the parietal lobe; and smaller thalamus volumes. They were also more likely to have WMLs in the frontal lobe (adjusted odds ratio = 1.08, 95% CI 0.9-1.3). Excluding participants with a depression diagnosis did not change the associations.
  
  
  CONCLUSIONS
  In this older population without dementia, apathy symptoms are associated with a more diffuse loss of both gray and white matter volumes, independent of depression.
authors.affiliation: From the Julius Center for Health Sciences and Primary Care (A.M.G., M.I.G.) and Department of Radiology (A.M.G.), University Medical Center Utrecht, the Netherlands; National Institute on Aging (M.I.G., M.E.G., T.B.H., L.J.L.), Laboratory for Epidemiology, Demography, and Biometry, Bethesda, MD; Icelandic Heart Association (S.S., G.E., P.V.J., K.S., V.G.), Kopavogur; Janus Rehabilitation (K.S.), Vorduskola v/Egilsgotu, Reykjavik; Landspitali University Hospital (T.S.), Reykjavik; and University of Iceland (V.G.), Reykjavik, Iceland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Grool
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Sigurdsson
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.forename: Palmi V
authors.initials: PV
authors.lastname: Jonsson
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Garcia
authors.forename: Kristin
authors.initials: K
authors.lastname: Siggeirsdottir
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Thordur
authors.initials: T
authors.lastname: Sigmundsson
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology*; D057565:Apathy; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000473:pathology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011569:Psychiatric Status Rating Scales
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