Cognitive Impairment and Affective Symptoms in Ischemic Heart Disease and Heart Failure: A Cross-sectional Study using the Addenbrooke’s Cognitive Examination-III
Abstract
Cardiovascular disease and heart failure are increasingly recognized contributors to late-life cognitive decline. However, data describing domain-specific cognitive profiles and psychiatric symptom burden in Indian cardiac cohorts remain limited. In a cross-sectional study of 86 adults aged ≥40 years with documented myocardial infarction and/or established heart failure, the participants were assessed using Addenbrooke’s Cognitive Examination-III (ACE-III). Depressive and anxiety symptoms were assessed using the Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Clinical variables included left ventricular ejection fraction (LVEF), NYHA functional class, cardiac diagnosis, illness duration, vascular comorbidities, and intervention history. Group comparisons used the Chi-square and t -test/Mann–Whitney tests. Associations were assessed using Spearman correlation and regression analysis. Cognitive impairment was highly prevalent: 55/86 (64.0%) scored below ACE-III dementia-range screening cutoffs (indicative of possible cognitive impairment), and 17/86 (19.8%) had mild cognitive impairment; mean ACE-III = 75.15 (SD 13.47). Attention and memory domains were most affected, with strong inter-domain correlations. LVEF correlated positively with ACE-III Total (rho ≈ 0.73, P ≈ 0.001), while NYHA class and age correlated negatively (NYHA vs ACE-III rho ≈ −0.747, P < 0.001). Longer disease duration and greater symptomatic severity were observed to be cross-sectionally associated with worse cognition. Depressive and anxiety symptoms were common across groups. In this single-center sample, lower LVEF, higher NYHA class, and longer cardiac disease duration were associated with marked cognitive dysfunction, especially in attention and memory, supporting a heart–brain nexus and the need for integrated cardiac/neuropsychiatric care.