Neurocognitive impairment after acute coronary syndrome: Prevalence and characterization in a hospital-based cardiac rehabilitation program sample

Abstract

Introduction: Prospective studies have shown the relation between acute coronary syndrome (ACS) and neurocognitive dysfunction with prevalence ranging between 10.51% and 66.8%. The present study aims to determine the prevalence level of neurocognitive dysfunction; the relations between sociodemographic, clinical and emotional variables and neurocognitive functioning in a sample of ACS patients. Methods: The sample comprised of 53 patients engaged in cardiac rehabilitation within 3 months after an ACS. Patients with any medical history of neuropsychiatric problems prior to the ACS and illiterate subjects were not included in the study. Results: The majority of the sample (85%) exhibits some degree of cognitive impairment, with 84.8% showing verbal fluency impairment, 60.3% memory impairment and only 26,4% had language compromised. Neurocognitive general functioning was correlated with age. Memory domain was negatively correlated with the number of daily smoked cigarettes before the ACS. Verbal fluency was influenced by schooling. Language domain was correlated with mean diastolic pressure and with the type of profession, visuospatial domain was correlated with schooling, number of cardiovascular risk factors, distress, anxiety levels and type of ACS. Conclusion: Prevalence rate of neurocognitive dysfunction is considerably high. Besides global neurocognitive functioning, verbal fluency and memory are the most affected domains. Several variables were related to neurocognitive performance: sociodemographic; cardiovascular risk factors; clinical; psychological. The underlying mechanisms of neurocognitive dysfunction should be further explored.

Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

“…The total sample from the nine studies included 6457 ACS patients (Table 3), ranging from 53 16 to 2174 17 patients between studies. The age mean of patients ranged from 51 16 to 77 years. 14 The proportion of males ranged from 57% 18 to 100%.…”

“…14 Of the nine studies, six were undertaken in the USA 14,15,17,19–21 and one each in the UK, 22 Spain 18 and Portugal. 16 Study designs included longitudinal cohort studies ( n = 8) 14,16–22 and a RCT ( n = 1). 15…”

“…Two studies investigated MI samples, 14,19 one study reported an ACS subgroup of 216 from a larger cohort of 614 patients, 22 and one study used cardiac rehabilitation patients with ACS as the cohort. 16…”

“…Three studies stratified the reported levels of CI: mild (TICS-M: 19–22) and moderate-severe (TICS-M: <19); 20 mild (SLUMS: 21–26) and dementia (SLUMS: ≤20); 15 and mild (ACE-III Z score <–1 and >–1.5), moderate (ACE-III Z score <–1.5 and >–2) and severe (ACE-III Z score <–2). 16 Two studies measured a specified range of CI severities: mild to moderate (SPMSQ: 3–7); 19 and mild to severe CI (SPMSQ: ≥3). 18 One study with multiple screening tools reported mild to moderate CI (MMSE: <24), 22 and also appeared to measure CI without reporting severity (TICS-M: <25 and MoCA: <26).…”

Prevalence and patterns of cognitive impairment in acute coronary syndrome patients: A systematic review

“…They concluded that the prevalence of neurocognitive dysfunction was high in this patient group, although their sample size was small. 9 Bedside measurement of mental status in elderly patients post ACS within 48 h of admission demonstrated cognitive impairment in approximately one-third of patients. This was then found to be associated with an increased risk of mortality at one year and an increase in rehospitalisation at three months.…”