title: Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation.
abstract: BACKGROUND
  Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far.
  
  
  METHODS
  In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI.
  
  
  RESULTS
  At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7%,P= 0.046), heavy (physically demanding) workloads (26.4 vs 17.8%,P< 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5%,P= 0.026), reduced exercise capacity (102.5 vs 118.8 W,P= 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m,P= 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95% confidence interval 1.07-2.79;P= 0.03) and heavy workloads (OR 2.18, 95% confidence interval 1.42-3.36;P< 0.01).
  
  
  CONCLUSIONS
  The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.
authors.affiliation: Center for Rehabilitation Research, University of Potsdam, Potsdam.
authors.forename: Annett
authors.initials: A
authors.lastname: Salzwedel
authors.affiliation: Center for Rehabilitation Research, University of Potsdam, Potsdam; Brandenburg Klinik, Bernau.
authors.forename: Maria-Dorothea
authors.initials: MD
authors.lastname: Heidler
authors.affiliation: Center for Rehabilitation Research, University of Potsdam, Potsdam.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Haubold
authors.affiliation: Brandenburg Klinik, Bernau.
authors.forename: Martin
authors.initials: M
authors.lastname: Schikora
authors.affiliation: Cardiological Outpatient Clinic, Am Park Sanssouci, Potsdam.
authors.forename: Rona
authors.initials: R
authors.lastname: Reibis
authors.affiliation: Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Brandenburg Klinik, Bernau.
authors.forename: Michael
authors.initials: M
authors.lastname: Jöbges
authors.affiliation: Center for Rehabilitation Research, University of Potsdam, Potsdam; Klinik am See, Rüdersdorf, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Völler
mesh_terms: D000041:Absenteeism; D000367:Age Factors; D000072038:Cardiac Rehabilitation; D016009:Chi-Square Distribution; D003071:Cognition; D060825:Cognitive Dysfunction / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D004522:Educational Status; D004651:Employment; D005260:Female; D005858:Germany / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010353:Patient Education as Topic; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload
keywords: acute coronary event; cardiac rehabilitation; cognitive impairment; patient education; prevalence