Empirical support for the vascular apathy hypothesis: A structured review

Area of Science:

• Neurology
• Gerontology
• Vascular Medicine

Background:

• Apathy is a common neuropsychiatric symptom.
• Its underlying mechanisms, particularly a potential vascular basis, require further investigation.

Purpose of the Study:

• To systematically review the relationship between subclinical small vessel disease (SSVD) and apathy in the general population.
• To evaluate the hypothesis that apathy has a vascular origin.

Main Methods:

• A systematic search was conducted for observational studies examining apathy and SSVD.
• SSVD was defined by neuroimaging (e.g., white matter hyperintensities, cerebral microbleeds) or peripheral markers (e.g., ankle-brachial index, hypertension).

Main Results:

• Fourteen studies were included, assessing various SSVD markers.
• Associations were found between apathy and white matter hyperintensities, cerebral microbleeds, cardiovascular disease, hypertension, and ankle-brachial index.
• Arterial stiffness and white matter diffusivity showed no relation to apathy; cortical thickness results were inconsistent.

Conclusions:

• Evidence supports a vascular basis for apathy, linking it to specific SSVD markers.
• Further prospective studies are needed to confirm these associations and control for vascular depression.