Aims This study aimed to determine the sensitivity and specificity of the National Institute of Neurological Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN) brief (5 min) screen composed of three items of the Montreal Cognitive Assessment (MoCA), in acute coronary syndrome (ACS) patients during hospital admission, relative to the full MoCA and potential alternative combinations of other items. Methods and results Participants were consecutively recruited during ACS admission and administered the MoCA before discharge. The three NINDS–CSN screen items were extracted, collated and compared to the full MoCA. Receiver operator characteristic (ROC) curves were created to determine the sensitivity, specificity, and appropriate cut-off scores of the screens. The mean age of the sample (n = 81) was 63.49 [standard deviation (SD) 10.85] years and 49.4% screened positive for cognitive impairment. The NINDS–CSN mean score was 9.22 (SD 2.09 of the potential range 0–12). Area under the ROC (AUC) indicated high accuracy levels for screening for cognitive impairment (AUC = 0.89, P < 0.01, 95% confidence interval 0.82, 0.96) with none of the alternative combination screens performing better on both sensitivity and specificity. A cut-off score of ≤10 on the NINDS–CSN protocol provided 83% sensitivity and 80% specificity for classifying cognitive impairment. Conclusion The NINDS–CSN protocol presents an accurate, feasible screen for cognitive impairment in patients following ACS for use at the bedside and potentially also for telephone screens. Diagnostic accuracy should be confirmed using a neurocognitive battery.
Background: Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission. Objective: In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI. Methods: Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screened with the Montreal Cognitive Assessment and the Hopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression. Results: Participants (n = 81) had a mean (SD) age of 63.5 (10.9) years, and 82.7% were male. In total, MCI was identified in 52.5%, 42.5% with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81. 5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of an MCI positive screen increased by 11% per year of age (odds ratio, 1.11; 95% confidence interval, 1.04-1.18) and by 3.6 times for those who are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09-11.89). Conclusion: An estimated half of patients with ACS screen positive for MCI during admission, with single and older patients most at risk. Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management.
Funding Acknowledgements Type of funding sources: None. Background Cognitive impairment (CI) is common in acute coronary syndrome (ACS) patients but is often undetected and may impact recovery and secondary prevention uptake. Health professionals play a vital role in the early detection of CI through screening and managing CI in ACS patients. Purpose To explore health professionals’ knowledge, attitudes, and behaviours toward CI screening in ACS patients Methods Cardiac health professionals were recruited via acute and outpatient cardiac wards in three metropolitan teaching hospitals and from emailing members of two cardiac professional associations in Australia. All completed a 38-item survey administered in either paper or electronic format. Results 100 health professionals responded (95 nurses and five allied health workers). Respondents identified the prevalence of CI, dementia, or delirium at 25% post-ACS (50% of respondents), and 74% identified difficulties in recalling recent information as the most common indicator of CI. The cognitive screening was performed at least some of the time in ACS patients by 73%. After accounting for age, receiving training in CI, work experience, and profession, cognitive screening was conducted more than eight times more often by health professionals who work in acute settings (OR=8.78, 95%CI 2.13, 36.25) versus non-acute. Participants identified the main reasons for conducting cognitive screening as early detection of change/establishing a baseline (n=27) and when they suspected any cognitive issue or decline (n=26). The most common barriers to both screening for CI and taking further actions when CI was detected were patients being unable to communicate well (60% and 49%), patients being too unstable/unwell (59% and 42%), and the priority being the patient’s clinical care (53% and 44%). Conclusions Health professionals working in acute settings are most likely to screen for CI regardless of experience or training in CI, leaving CI likely to be undetected in ACS patients receiving care in other settings. Barriers to screening are common and challenging to address due to time shortages and the appropriateness of tools. A standardised screening guideline and more feasible screening tools are needed to overcome the barriers to cognitive screening in ACS patients. Pre-professional education should also be implemented in the future.
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