ABSTRACT
Background: Better understanding of the prevalence of unappreciated cognitive dysfunction among patients with cardiovascular disease during hospitalization is integral to patient-centered care. We tested the hypothesis that there is a substantial prevalence of debilitating cognitive dysfunction in cardiac patients which health care providers do not appreciate. Methods: This observational prospective study evaluated 51 patients on admission to a cardiac intensive care unit (CICU) who did not have a history of conditions known to adversely affect cognition and appeared cognitively intact to treating physicians and nursing staff. Patients underwent neuropsychological testing to assess the domains of global cognition, attention, memory, and executive function at important points during hospitalization. Results: Twenty-six percent of participants were impaired globally based upon the Modified Mini Mental Status Examination. Of the study’s participants, 46% were impaired in memory on short recall and 40% were impaired on long recall based upon Rey Auditory Verbal Learning, while 49% were impaired based upon Digit Span. Further, 38% of participants were impaired in attention based upon Trail Making Test Part A. Twenty-five percent of participants were impaired in executive function based upon Trail Making Test Part B, and 18% were impaired based upon Frontal Assessment Battery. Conclusions: In patients hospitalized with cardiovascular disease, unappreciated cognitive dysfunction is common. The dysfunction involves multiple domains and likely impedes patient participation in longitudinal care and their comprehension of health education which ultimately hinders the transition from hospital to home care. This process creates a setting of poor self-management with significantly increased potential for rehospitalizations.
ABSTRACT
Background: Several of the comorbidities and risk factors associated with COPD and other pulmonary disorders are also similar to those for lower extremity peripheral artery disease (PAD) and cerebrovascular disease. The later condition is often manifested as cognitive impairment, not only from large vessel associated stroke, but also from vascular cognitive impairment (VCI). We hypothesized that pulmonary rehabilitation (PR) would be an appropriate site to discern the prevalence of both PAD and mild cognitive impairment (MCI). Individuals in PR with severe pulmonary disease may have impaired cognition, which could impact learning and treatment adherence while PAD may contribute to functional limitation. Study Design: In this pilot study of 14 patients enrolled in phase II PR, we describe the prevalence of PAD and cognitive impairment, the utility of screening tools, and the potential relationship between PAD, depression, and cognitive impairment. Results: Twenty-eight percent of patients had an abnormal ABI with two subjects manifesting low (<0.90) and two subjects with abnormally high (>1.40) ABI. The Edinburgh Claudication Questionnaire was negative in all subjects and was not useful in the detection of PAD (sensitivity 0%, specificity 11%, PPV 0%, NPV 78.57%). The Walking Impairment Questionnaire did not differentiate patients with or without abnormal ABIs with respect to walking distance (40.02 vs. 64.46 meters, P=.154), speed (27.15 vs. 25.92 miles per hour, P=.545), or symptoms (46.88 vs. 63.75, P=.152). Furthermore, eleven of the fourteen patients (79%) had an overall score of less than 26 on the Montreal Cognitive Assessment, indicating cognitive impairment. Scores indicating mild to moderate depression or anxiety measured by the PHQ-9 and STAI questionnaires revealed a concurrence between depressive and anxiety symptoms. Conclusion: Our results have leaded us to postulate a possible relationship between PAD and MCI, along with that of PAD and depression and anxiety. Future studies, with a large sample size, will provide more insight on ameliorating care for patients whose vascular disease affects cognitive function and mental health.