Cognitive Impairment and Psychological State in Acute Coronary Syndrome Patients: A prospective descriptive study at Cardiac Rehabilitation Entry, Completion and Follow-up

Background: Cognitive impairments (CI) may limit uptake of secondary prevention in acute coronary syndrome (ACS) patients but is poorly understood, including in cardiac rehabilitation (CR) participants. Aim: To explore CI in relation to psychological state in ACS patients over the course of CR and follow-up. Methods: ACS patients without diagnosed dementia were assessed on verbal learning, processing speed, executive function and visual attention, at CR 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% male. Mild CI occurred at CR entry in single 62.5% and multiple domains 22.5% but was significantly less prevalent by CR 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 CR completion 42.5%, follow-up 22.5%; processing speed CR completion 15.0%, follow-up 15.0%). A small group of patients had persistent multiple domain CI. At CR entry patients with CI in processing speed, a single domain or multiple domains had more depression, and patients with CI in executive function had more depression and anxiety. Conclusions: At CR entry, mild CI is very common in post-ACS patients and worse in patients who have depression or anxiety symptoms. CI decreases significantly by CR follow-up. A small proportion of patients have persistent, multiple domain CI flagging potential long-term changes and the need for further investigations and cognitive rehabilitation