title: Verbal memory performance and completion of cardiac rehabilitation in patients with coronary artery disease.
abstract: OBJECTIVE
  To assess cognitive performance as a predictor of noncompletion of cardiac rehabilitation (CR) using a standardized verbal memory test.
  
  
  METHODS
  This was a prospective cohort study of consecutive patients with coronary artery disease (n = 131) entering 1-year outpatient CR between April 2007 and May 2009. Verbal memory performance was assessed using the California Verbal Learning Test, Second Edition. Attendance at weekly CR sessions was recorded, and completion or noncompletion was determined according to comprehensive CR criteria. Depression was diagnosed according to DSM-IV criteria as a possible confounder.
  
  
  RESULTS
  Verbal memory performance at entry into CR differed significantly (F(1,130) = 7.80, p = .006) between noncompleters and completers (mean [SD] cumulative California Verbal Learning Test, Second Edition, score, -1.15 [2.59] versus 0.47 [3.12]) in analysis of covariance controlling for pertinent clinical confounders. Better verbal memory performance predicted a reduced risk of noncompletion (hazard ratio [HR] = 0.86, 95% confidence interval [CI] = 0.77-0.96, p = .009) in time-to-event analysis adjusted for depression (HR = 2.62, 95% CI = 1.33-5.17, p = .006) and smoking history (HR = 2.03, 95% CI = 0.98-4.22, p = .06). A post hoc analysis suggested that better verbal memory performance predicted a reduced risk of noncompletion for medical reasons (HR = 0.83, 95% CI = 0.70-0.99, p = .03).
  
  
  CONCLUSIONS
  Poorer verbal memory performance was associated with an increased risk of noncompletion of CR among participants with coronary artery disease. Further studies exploring practical methods for screening and targeted support might improve rehabilitation outcomes.
authors.affiliation: Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Swardfager
authors.forename: Nathan
authors.initials: N
authors.lastname: Herrmann
authors.forename: Susan
authors.initials: S
authors.lastname: Marzolini
authors.forename: Paul I
authors.initials: PI
authors.lastname: Oh
authors.forename: Mahwesh
authors.initials: M
authors.lastname: Saleem
authors.forename: Prathiba
authors.initials: P
authors.lastname: Shammi
authors.forename: Alexander
authors.initials: A
authors.lastname: Kiss
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Cappell
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lanctôt
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000523:psychology* / Q000534:rehabilitation; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D010349:Patient Compliance / Q000523:psychology*; D016896:Treatment Outcome; D014706:Verbal Learning