Exploring Cognitive Concomitants of Mental Fatigue in Patients with Coronary Artery Disease

Abstract

Objective: Fatigue and reduced exercise capacity are common concomitants of coronary artery disease (CAD). They are known to be associated with the deterioration in mental health, including emotional and cognitive status. However, the precise nature of the inter-relationship is poorly understood. The aim of this study was to investigate the relationship between fatigue and exercise capacity on the one hand and changes in cognitive functioning on the other, to generate new heuristics for clinical management and outcome prediction of CAD. Methods: A cross-sectional study included 827 in-patients (58 ± 9 years, 75% men) with CAD. Patients were evaluated for demographic, cardiac characteristics, and exercise capacity. The Multidimensional Fatigue Inventory-20 was used to assess fatigue, the Mini Mental State Examination for global cognitive function, the Digit Span Test, Digit Symbol Test, and Trail Making Test for executive aspects of cognitive functioning, and the Hospital Anxiety and Depression Scale for anxiety and depression symptom severity. Results: Using multiple regression analysis, after adjusting for possible confounders such as anxiety and depression, mental fatigue was associated with several executive aspects of cognitive function including short-term memory (Digit Symbol Test pairs recalled correctly [β = –0.127, p < 0.005]), psychomotor performance (time to complete the Digit Symbol Test [β = 0.089, p < 0.03]), and cognitive processing speed (Trail Making Test A [β = 0.081, p < 0.05]). Conclusion: In rehabilitating CAD patients, certain aspects of executive functioning were independently associated with mental fatigue. These findings suggest that the subjective experience of mental fatigue, rather than reduced exercise capacity, is significantly associated with cognitive function.

Fatigue, Social Support, and Depression in Individuals With Coronary Artery Disease

“…Furthermore, these associations were independent of various potential confounders, such as sex, age, NYHA functional class, and anxiety. Since subjective fatigue and perceived social support are closely linked to health outcomes in individuals with CAD (Smith et al, 2008;Barth et al, 2010;Burkauskas et al, 2017), it is important to determine the presence of fatigue and its features, and how they could be predicted by the perceived social support in those individuals early and accurately, as well as adapt the rehabilitation program accordingly. Since one of the main symptoms of depression is fatigue (Bunevicius et al, 2012), a further intervention that focuses on the treatment of depression is likely to be beneficial.…”

“…Fatigue is a common symptom to various medical and mental conditions, including cancer, multiple sclerosis, major depression, schizophrenia, and heart related conditions, which may impair quality of life (Chung et al, 2014;Hedlund et al, 2015;Mohandas et al, 2017;Rottoli et al, 2017). Considering the context, CAD is not an exception, since fatigue is a common disturbing symptom in individuals with this particular diagnosis, linked to poor cognitive performance (Burkauskas et al, 2017) and worse health related quality of life (Staniute et al, 2014). In fact, fatigue is often present as a core somatic symptom of depression that is one of the most common comorbid mental health conditions in those with CAD (Smith et al, 2008;Alsen and Brink, 2013).…”

Prevalence of pharmacological adherence in patients with coronary artery disease and associated factors

“…Regarding the pharmacological treatment, the mean duration of this treatment was less than the time since the diagnosis. This can occur because, at some point, many patients interrupt treatment due to lack of financial resources ( 8 ) , the belief that treatment would be unnecessary while they are asymptomatic or to the complex therapeutic scheme, with associated side effects ( 21 ) .…”

“…Among the variables related to the disease, fatigue and palpitation were significantly associated with adherence in the univariate analysis and remained associated in the multiple analysis. Fatigue is a prevalent, disabling and persistent symptom in patients with CAD ( 21 ) . In a study conducted with patients undergoing percutaneous coronary intervention, this symptom was associated with the side effects of the medications ( 22 ) .…”

Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease

“…Fatigue, defined as the multidimensional subjective experience of persistent and extreme tiredness, mental and physical exhaustion (Smets et al, 1995;Ream and Richardson, 1996;Aaronson et al, 1999), is one of the most frequent and distressing symptoms reported by patients with CAD after ACS (Burkauskas et al, 2017;Johnston and Eckhardt, 2018). In patients with CAD, the prevalence of moderate to severe fatigue has been reported to be as high as 39% during cardiac rehabilitation (CR), remaining up to 28% after 1 year (van Geffen et al, 2015).…”