• Jonathan Tay, Robin G Morris, Anil M Tuladhar, Masud Husain, Frank-Erik de Leeuw, and Hugh S Markus.
• Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK jt629@medschl.cam.ac.uk.
• J. Neurol. Neurosurg. Psychiatr. 2020 Sep 1; 91 (9): 953959953-959.

ObjectiveTo determine whether apathy or depression predicts all-cause dementia in small vessel disease (SVD) patients.MethodsAnalyses used two prospective cohort studies of SVD: St. George's Cognition and Neuroimaging in Stroke (SCANS; n=121) and Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC; n=352). Multivariate Cox regressions were used to predict dementia using baseline apathy and depression scores in both datasets. Change in apathy and depression was used to predict dementia in a subset of 104 participants with longitudinal data from SCANS. All models were controlled for age, education and cognitive function.ResultsBaseline apathy scores predicted dementia in SCANS (HR 1.49, 95% CI 1.05 to 2.11, p=0.024) and RUN DMC (HR 1.05, 95% CI 1.01 to 1.09, p=0.007). Increasing apathy was associated with dementia in SCANS (HR 1.53, 95% CI 1.08 to 2.17, p=0.017). In contrast, baseline depression and change in depression did not predict dementia in either dataset. Including apathy in predictive models of dementia improved model fit.ConclusionsApathy, but not depression, may be a prodromal symptom of dementia in SVD, and may be useful in identifying at-risk individuals.© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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