Predictive Accuracy of Inpatient Cognitive Screening for Correctly Classifying Mild Cognitive Impairment at 4 Months Using A Full Neurocognitive Battery in Acute Coronary Syndrome

Abstract

D ementia is a leading contributor to the global burden of disease due to progressive and unrelenting deterioration of the capacity of an individual to live independently. Vascular etiology is the second most common cause of dementia 1 and cardiovascular disease (CVD) results in faster decline. 2 Mild cognitive impairment (MCI), which may indicate early dementia, occurs frequently in acute coronary syndrome (ACS) patients. 3 Prevalence rates vary widely (9-85%), depending on timing and assessment method used. A recent report indicated 63% had MCI on screening 4 4-wk post-ACS. Data based on full neurocognitive assessment when recovery has progressed (4-mo post-ACS) are required for confirmation and to inform inpatient screening that reliably predicts MCI. Early detection of MCI enables timely intervention to potentially slow the progression of MCI to dementia and enable customizing of education and support. METHODSWe recruited consecutive ACS inpatients from two university hospitals in metropolitan Sydney, Australia. Included patients were free from dementia and proficient in English. Inpatient screening for MCI was undertaken using the Montreal Cognitive Assessment (MoCA) 5 and the Hopkins Verbal Learning Test (HVLT). 6 Together, these tests are sensitive to the cognitive decline common in vascular cognitive impairment. Mild cognitive impairment was classified as MoCA score <26 and/or HVLT ≥ −1 z-score. Participants were then assessed 4-mo post-ACS using a full neurocognitive battery conducted by qualified neuropsychologists in an accredited testing center (see Supplemental Digital Content Table 1, available at: http://links.lww.com/JCRP/A432). Testing determined if patients met clinical criteria for MCI, as well as classification of amnestic and nonamnestic MCI