Unappreciated Cognitive Dysfunction is Common among Patients Hospitalized with Cardiovascular Disease
James V. Cireddu
University Hospitals Harrington Heart and Vascular, Cleveland, Ohio, USA and Case Western Reserve University, Cleveland, Ohio, USA and MetroHealth Heart and Vascular, Cleveland, Ohio, USA.
Mary A. Dolansky
University Hospitals Harrington Heart and Vascular, Cleveland, Ohio, USA and Case Western Reserve University, Cleveland, Ohio, USA.
Denise Lin- DeShetler
Case Western Reserve University, Cleveland, Ohio, USA.
Joel Hughes
Kent State University, Kent, Ohio, USA and Summa Health System, Akron, Ohio, USA.
John Gunstad
Kent State University, Kent, Ohio, USA and Summa Health System, Akron, Ohio, USA.
Richard Josephson *
University Hospitals Harrington Heart and Vascular, Cleveland, Ohio, USA and Case Western Reserve University, Cleveland, Ohio, USA.
*Author to whom correspondence should be addressed.
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.
Keywords: Cardiovascular disease, cognition, executive function, memory