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Lisa SM Eurelings,1,* Jan Willem van Dalen,1,* Gerben ter Riet,2 Eric P Moll van Charante,2 Edo Richard,1,3 Willem A van Gool1 On behalf of the ICARA Study Group 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 2Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 3Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands *These authors contributed equally to this work Background: Previous findings suggest that apathy symptoms independently of depressive symptoms measured using the Geriatric Depression Scale (GDS) are associated with cardiovascular disease (CVD) in older individuals.Aims: To study whether apathy and depressive symptoms in older people are associated with future CVD, stroke, and mortality using individual patient-data meta-analysis.Methods: Medline, Embase, and PsycInfo databases up to September 3, 2013, were systematically searched without language restrictions. We sought prospective studies with older (mean age ≥65 years) community-dwelling populations in which the GDS was employed and subsequent stroke and/or CVD were recorded to provide individual participant data. Apathy symptoms were defined as the three apathy-related subitems of the GDS, with depressive symptoms the remaining items. We used myocardial infarction (MI), stroke, and all-cause mortality as main outcomes. Analyses were adjusted for age, sex, and MI/stroke history. An adaptation of the Newcastle–Ottawa scale was used to evaluate bias. Hazard ratios were calculated using one-stage random-effect Cox regression models.Results: Of the 52 eligible studies, 21 (40.4%) were included, comprising 47,625 older people (mean age [standard deviation] 74 [7.4] years), over a median follow-up of 8.8 years. Participants with apathy symptoms had a 21% higher risk of MI (95% confidence interval [CI] 1.08–1.36), a 37% higher risk of stroke (95% CI 1.18–1.59), and a 47% higher risk of all-cause mortality (95% CI 1.38–1.56). Participants with depressive symptoms had a comparably higher risk of stroke (HR 1.36, 95% CI 1.18–1.56) and all-cause mortality (HR 1.44, 95% CI 1.35–1.53), but not of MI (HR 1.08, 95% CI 0.91–1.29). Associations for isolated apathy and isolated depressive symptoms were comparable. Sensitivity analyses according to risk of bias yielded similar results.Conclusion: Our findings stress the clinical importance of recognizing apathy independently of depressive symptoms, and could help physicians identify persons at increased risk of vascular disease. Keywords: apathy, older people, depression, cardiovascular disease, meta-analysis, stroke, myocardial infarction

Eurelings LSM, van Dalen JW, ter Riet G, et al. Clin Epidemiol. 2018;10:363–379.Page 363, affiliations section, “On behalf of the ICARA Study Group” should instead read “and the ICARA study group”. Read the original article

Lara Siebeling,1 Sarah Wiebers,2 Leo Beem,1 Milo A Puhan,3 Gerben ter Riet11Department of General Practice, 2Faculty of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USABackground: Physical activity (PA) is important in older adults for the maintenance of functional ability. Assessing PA may be difficult. Few PA questionnaires have been compared to activity monitors. We examined reproducibility and validity of the self-administered Longitudinal Ageing Study Amsterdam Physical Activity Questionnaire (LAPAQ) against a triaxial accelerometer (ACTR) (Sensewear® Pro) in older adults.Methods: Participants wore the ACTR continuously for two weeks. After 2 (T [time] = 1) and 4 (T = 2) weeks, participants completed the LAPAQ. Since the LAPAQ asks about 2 weeks’ worth of physical activity, the ACTR and LAPAQ coincided at T1. T2 was used to assess the reproducibility of the LAPAQ results only. We calculated Pearson’s correlation coefficients (PCC) to examine reproducibility and validity. For visualization, we used scatterplots and Bland–Altman plots. With a receiver operating characteristics (ROC) curve we assessed how well the LAPAQ identifies older adults whose activity level is below official recommendations.Results: A total of 89 persons were included. Of the participants, 48% were men; median age was 73, and median body mass index was 25. The 2-week mean total duration of activity was 2788 (ACTR, T = 1), 2439 (LAPAQ T = 1), and 1994 (LAPAQ T = 2) minutes. As a reference, 2 full weeks contained 20,160 minutes. Reproducibility of the LAPAQ was moderate (PCC 0.68, 95% CI 0.55–0.80). The median difference between LAPAQ at T = 1 and the ACTR (LAPAQ minus ACTR) was –510 minutes and the PCC was 0.25 (95% CI 0.07–0.44). The area under the ROC curve was 0.73 (95% CI 0.59–0.86).Conclusion: LAPAQ underestimates PA and seems unsuitable for exact measurement in older adults. However, it may be used to determine if a person’s PA level is below the recommended level.Keywords: physical activity, elderly, validation, questionnaire, accelerometer

Lara Siebeling1, Milo A Puhan2,3, Patrick Muggensturm4, Marco Zoller5, Gerben ter Riet11Department of General Practice, Academic Medical Center, University of Amsterdam, The Netherlands; 2Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 3Horten Center for Patient-oriented Research, University of Zurich, 4Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland; 5Department of General Practice, University of Zurich, Zurich, SwitzerlandIntroduction: International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) is a prospective cohort study with chronic obstructive pulmonary disease (COPD) patients from Switzerland and The Netherlands designed to develop and validate practical COPD risk indices that predict the clinical course of COPD patients in primary care. This paper describes the characteristics of the cohorts at baseline.Material and methods: Standardized assessments included lung function, patient history, self-administered questionnaires, exercise capacity, and a venous blood sample for analysis of biomarkers and genetics.Results: A total of 260 Dutch and 151 Swiss patients were included. Median age was 66 years, 57% were male, 38% were current smokers, 55% were former smokers, and 76% had at least one and 40% had two or more comorbidities with cardiovascular disease being the most prevalent one. The use of any pulmonary and cardiovascular drugs was 84% and 66%, respectively. Although lung function results (median forced expiratory volume in 1 second [FEV1] was 59% of predicted) were similar across the two cohorts, Swiss patients reported better COPD-specific health-related quality of life (Chronic Respiratory Questionnaire) and had higher exercise capacity.Discussion: COPD patients in the ICE COLD ERIC study represent a wide range of disease severities and the prevalence of multimorbidity is high. The rich variation in these primary care cohorts offers good opportunities to learn more about the clinical course of COPD.Keywords: COPD, exacerbation, health-related quality of life, prediction, prognosis

Siebeling L, Puhan MA, Muggensturm P, Zoller M, ter Riet G. Characteristics of Dutch and Swiss primary care COPD patients – baseline data of the ICE COLD ERIC study. Clin Epidemiol. 2011;3:273–283.Due to two duplicate records, the correct number of patients in the Ice Cold Eric study is 409, not 411. The reported results did not materially change. Those who wish to see the updated tables may contact the corresponding author.Read the original article