年龄和婚姻状况可预测急性冠脉综合征入院期间的轻度认知障碍：一项急性冠脉综合征住院患者的观察性研究

Age and Marital Status Predict Mild Cognitive Impairment During Acute Coronary Syndrome Admission: An Observational Study of Acute Coronary Syndrome Inpatients.

作者信息

Weddell Joseph, Naismith Sharon L, Bauman Adrian, Tofler Geoffrey, Zhao Emma, Redfern Julie, Buckley Tom, Gallagher Robyn

出版信息

J Cardiovasc Nurs. 2023;38(5):462-471. doi: 10.1097/JCN.0000000000000964. Epub 2022 Dec 21.

DOI:10.1097/JCN.0000000000000964

PMID:36729065

Abstract

BACKGROUND

Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission.

OBJECTIVE

In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI.

METHODS

Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screened with the Montreal Cognitive Assessment and the Hopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression.

RESULTS

Participants (n = 81) had a mean (SD) age of 63.5 (10.9) years, and 82.7% were male. In total, MCI was identified in 52.5%, 42.5% with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81.5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of an MCI positive screen increased by 11% per year of age (odds ratio, 1.11; 95% confidence interval, 1.04-1.18) and by 3.6 times for those who are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09-11.89).

CONCLUSION

An estimated half of patients with ACS screen positive for MCI during admission, with single and older patients most at risk. Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management.

摘要

背景

急性冠状动脉综合征（ACS）后曾有轻度认知障碍（MCI）的报道，但尚不确定哪些人有风险，尤其是在住院期间。

目的

在本研究中，我们旨在探讨ACS住院期间MCI的患病率及受影响的认知领域，并确定最易发生MCI的患者的识别因素。

方法

从2家三级医院心脏科病房连续招募ACS住院患者，并用蒙特利尔认知评估量表和霍普金斯词语学习测验进行筛查。筛查内容包括健康素养（最新生命体征）、抑郁症状（患者健康问卷-9）和身体活动（老年人身体活动量表）。使用逻辑回归确定与MCI相关的因素。

结果

参与者（n = 81）的平均（标准差）年龄为63.5（10.9）岁，82.7%为男性。总计，52.5%的患者被诊断为MCI，其中42.5%通过单项筛查确诊，10%通过两项筛查均确诊。单独来看，蒙特利尔认知评估量表筛查出48.1%的患者患有MCI，霍普金斯词语学习测验筛查出13.8%的患者患有MCI。在蒙特利尔认知评估量表筛查中，参与者最常未获得满分的认知领域为延迟回忆（81.5%）、视觉空间执行功能（48.1%）和注意力（30.9%）。在考虑教育程度、抑郁、身体活动和ACS诊断因素后，MCI筛查呈阳性的可能性随年龄每增加1岁而增加11%（比值比，1.11；95%置信区间，1.04-1.18），未婚/无伴侣者的可能性增加3.6倍（比值比，3.61；95%置信区间，1.09-11.89）。