Unrecognized Cognitive Impairment in Cardiac Rehabilitation Patients

Abstract

To determine the prevalence of unrecognized brain dysfunction accompanying chronic severe cardiac disease, we examined 20 clinically stable consecutive admissions to a cardiac rehabilitation service who were free of known stroke or dementia. Age range was 47 to 85 years (mean +/- SEM, 72.5 +/- 2.1 years), the male: female ratio was 10:10. Multiple cognitive deficits including significant memory impairment and disorientation were present in eight patients (40%), and seven of these eight patients were unable to administer their own medications reliably. An additional six patients (30%) showed milder impairments. One patient was found to be normal after neurological examination, four showed evidence of a single brain lesion, and 15 of 20 (75%) had multiple neurological abnormalities suggesting multifocal brain disease. The mechanism of cognitive deficits in cardiac patients is unclear, and it may be related to multiple infarcts, or acute or chronic hypoxic damage secondary to arrhythmias, cardiac failure, or small vessel disease of the brain. The term "circulatory dementia" is proposed to describe patients with vascular disease and non-Alzheimer type dementia. Patients with cardiac disease should undergo cognitive screening, as early identification of patients at risk of progressive intellectual loss may allow early use of preventive therapy.

The Relationship Between Signs of Cardiovascular Deficiency and Cognitive Performance in Old Age: A Population-Based Study

“…First, CVS may reflect a more generalized vascular disturbance, with resulting effects on the central nervous system. Second, the CVS observed may be indicative of heart failure resulting in hypoperfusion in the brain (Barclay et al, 1988;Meyer et al, 1995). In contrast, CVS was unrelated to digit span and verbal fluency.…”

“…Three specific CVS were targeted (i.e., cardiac murmur, dyspnea, edema in lower limbs), all of which may be indicative of congestive heart failure (Barclay et al, 1988;O'Keeffe & Lye, 1998).…”

“…For example, Barclay, Weiss, Mattis, Bond, and Blass (1988) examined patients with severe CVD who were free from stroke and dementia. Marked cognitive deficits, including memory problems, were observed in 40% of the study sample.…”

Vascular Dementia Prevention: A Risk Factor Analysis

“…Patients with VaD may also be found in stroke clinics and rehabilitation services, in particular among patients recovering from stroke, undergoing cardiac rehabilitation after myocardial infarction [53, 54], or in convalescence units after major surgery, in particular coronary artery bypass graft [55, 56] and hip fracture repair [57]. Patients with severe behavioral manifestations (apathy, agitation, uninhibited behavior) are usually seen by geriatric psychiatrists who have coined the term ‘depression-executive dysfunction syndrome of late life’ for this clinical syndrome [58, 59].…”

Cognitive Impairment among Elderly Coronary Heart Disease Patients

“…Cross-sectional clinical studies have shown cognitive impairment to be associated with cardiac arrest [6], arteriosclerosis [7], hypertension [8], CHD [8,9] and myocardial infarction (MI) [10] among the elderly. A recent longitudinal study among 73 male managers also showed CVDs to be predictors of cognitive impairment among the elderly [11].…”