Cognitive impairment and psychological state in acute coronary syndrome patients: A prospective descriptive study at cardiac rehabilitation entry, completion and follow-up

Abstract

Background Cognitive impairment may limit the uptake of secondary prevention in acute coronary syndrome patients, but is poorly understood, including in cardiac rehabilitation participants. Aim The aim of this study was to explore cognitive impairment in relation to psychological state in acute coronary syndrome patients over the course of cardiac rehabilitation and follow-up. Methods Acute coronary syndrome patients without diagnosed dementia were assessed on verbal learning, processing speed, executive function and visual attention, at cardiac rehabilitation entry, completion and follow-up and scores adjusted using normative data. The hospital anxiety and depression scale measured psychological state. Results Participants ( n = 40) had an average age of 66.2 (±8.22) years and were 70% men. Mild cognitive impairment occurred at cardiac rehabilitation entry in single 62.5% and multiple 22.5% domains but was significantly less prevalent by cardiac rehabilitation completion (52.5% and 15.0%) and follow-up (32.5% and 7.0%). Domains most often impaired were verbal learning (52.5%) and processing speed (25.6%), again decreasing significantly with time (verbal learning cardiac rehabilitation completion 42.5%, follow-up 22.5%; processing speed cardiac rehabilitation completion 15.0%, follow-up 15.0%). A small group of patients had persistent multiple domain cognitive impairment. At cardiac rehabilitation entry patients with cognitive impairment in processing speed, a single domain or multiple domains had more depression, and patients with cognitive impairment in executive function had more depression and anxiety. Conclusions At cardiac rehabilitation entry, mild cognitive impairment is very common in post-acute coronary syndrome patients and worse in patients who have depression or anxiety symptoms. Cognitive impairment decreases significantly by cardiac rehabilitation follow-up. A small proportion of patients has persistent, multiple domain cognitive impairment flagging potential long-term changes and the need for further investigations and cognitive rehabilitation.

Age and Marital Status Predict Mild Cognitive Impairment During Acute Coronary Syndrome Admission

“…This was replicated in this study with the MoCA failing to detect 3 of 81 positive HVLT screens (3.7%) and the HVLT failing to detect 31 of 81 (38.3%) of the positive MoCA screens, likely due to the MoCA testing several cognitive domains compared with the HVLT testing only new verbal learning. The prevalence of MCI has been identified in 28.9% at 4 weeks post ACS using 2 cognitive screens, and 62.5% single-domain and 22.5% multiple-domain MCI at cardiac rehabilitation entry using a battery of 5 neuropsychological tests 10,12 . One explanation for these high MCI rates in ACS could be the shared pathology and coexistence of vascular cognitive impairment and coronary heart disease 7 .…”

“…The prevalence of MCI has been identified in 28.9% at 4 weeks post ACS using 2 cognitive screens, and 62.5% single-domain and 22.5% multiple-domain MCI at cardiac rehabilitation entry using a battery of 5 neuropsychological tests. 10,12 One for these high MCI rates in ACS could be the shared pathology and coexistence of vascular cognitive impairment and coronary heart disease. 7 Neurovascular dysfunction, increased blood-brain barrier permeability, and microvascular thrombosis are all mediated by endothelial damage, which is triggered by vascular risk factors.…”

“…14 During the early ACS recovery period, MCI has been identified in 28.9% at 4 weeks post discharge 10 and has been reported in 62.5% single and 22.5% multiple neurocognitive domains at cardiac rehabilitation entry, significantly resolving by cardiac rehabilitation completion and follow-up. 12 However, studies exploring prevalence rates and cognitive domains most affected during ACS admission are lacking and generally use a single cognitive screening instrument, instead of 2 screens, which has been demonstrated to yield a more accurate representation. 10 Screening for MCI during ACS is beneficial because, before discharge, ACS inpatients have large amounts of complex information to process regarding managing their condition, which then must be initiated post discharge.…”

Depression and Anxiety Are Associated with Physical Performance in Patients Undergoing Cardiac Rehabilitation: A Retrospective Observational Study

“…Cardiac rehabilitation (CR) is a program for cardiovascular patients to improve their cardiovascular prognosis, quality of life, and activities of daily living. Mild cognitive impairment is very common in post-acute coronary syndrome patients and makes worse symptoms of depression or anxiety [1]. Exercise-based CR itself improves the psychological state, and completion of a 12-month CR program was associated with a significant reduction of clinical psychological distress [2].…”

Engaging Patients in Lifestyle Behaviour Change in Cardiovascular Secondary Prevention: Understanding the Complexity

“…Public health concerns are increasingly about the impact of psychosocial risk factors on wellbeing, and health and recognition of such risk factors in the development of improved cardiovascular secondary prevention interventions is required. Further, persistent cognitive impairment post-acute coronary syndrome (ACS) (prevalence up to 85%) has also been identified as a barrier to CR attendance, limiting memory and recall, and is worse in patients who have depression and anxiety [19,20].…”