![]() ![]() ![]() Examples include the Addenbrooke’s Cognitive Examination III, Cognitive Abilities Screening Instrument, mini-mental state examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the National Institute of Neurological Disorders and Stroke and the Canadian Stroke Network (NINDS–CSN) brief screen. The selection of a suitable screening tool is complicated by the lack of recommendations for the ACS population and the availability of multiple screening options with unique thresholds for differentiating cognitive impairment. Identification of a screen suitable for bedside assessment and increasingly for remote assessments is needed for the contemporary management of ACS. A positive screen for cognitive impairment is not a medical diagnosis but does alert nurses to patients who may need additional support and potentially further neurocognitive assessment. Current guidelines for ACS do not include cognitive screening. However, cognitive impairment without dementia can be subclinical, 15 and screening is often necessary to help identify ACS patients who are affected and therefore most at risk of worse health outcomes. 12 International guidelines for ACS care from the European Society of Cardiology and the American Heart Association recommend that cognitive impairment is taken into account in the older patient (≥75 years of age). 8 Cognitive impairment post-ACS is associated with worse outcomes including major adverse cardiac events such as recurrent myocardial infarction, 9 worse modifiable risk factor profiles, 10 and worse health literacy, 11 and affected patients report many challenges in cardiac rehabilitation management. 6, 7 The relationship between ACS and cognitive impairment is poorly understood and reported prevalence rates to range from 11% to 85% in the first 3 months. 4Ĭognitive impairment is associated with CHD, with individuals diagnosed with CHD having a 45% increased risk of developing cognitive impairment or dementia, 5 and development of CHD is associated with accelerated cognitive decline. 2 Importantly, despite significant improvements in CHD treatments, 21.5% of acute coronary syndrome (ACS) patients are readmitted within a year 3 and 14% within 30 days. ![]() 1 Coronary heart disease is one of the most common reasons for hospital admission, often following an Emergency Department presentation. Heart diseases, including coronary heart disease (CHD), are the leading cause of death globally, causing 16% of all deaths and contributing substantially to healthy life-years lost and economic burden. We identified a brief three-item screen (5 min) that is both sensitive and specific at detecting mild cognitive impairment in acute coronary syndrome patients during admission.Ĭlinicians can now use this screen to quickly identify the potential for cognitive impairment to limit learning pre-discharge and adapt education strategies accordingly.Ī positive screen on this National Institute of Neurological Disorders and Stroke and the Canadian Stroke Network brief protocol flags but does not diagnose cognitive impairment, and further testing is recommended. ![]()
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