Type D personality is associated with worse cognitive functioning of CAD patients

1543-3633_coverpageWhile studies have linked depression, anxiety and cognitive decline, very little research to date has focused on how mental distress symptoms might affect cognitive functioning in coronary artery disease (CAD) patients. “These findings underscore the need to consider depressive and state anxiety symptoms when interpreting the cognitive function of patients with CAD” says Julius Neverauskas, an author of the new paper just published in Cognitive and Behavioral Neurology.

Led by late Dr. Robertas Bunevičius, the research team wanted to investigate how depression, anxiety, and Type D personality relate to cognitive function in patients with CAD, adjusting for sociodemographic factors and clinical markers of CAD severity. They evaluated 510 consecutive patients with CAD but no history of coronary artery bypass graft surgery or cognitive impairment who were attending a cardiac rehabilitation program. Authors found that depressive, anxiety symptom severity and Type D personality correlated with cognitive impairment independent of age, sex, education, and clinical CAD severity. Specifically, depression symptom severity was linked to impaired psychomotor performance, especially in the execution of complex cognitive tasks. Authors found that CAD patients’ state anxiety symptoms correlated with their mental flexibility and perceptual speed. They also found that Type D personality was correlated with global cognitive functioning.

The Journal spoke with the Lithuanian Society of Biological Psychiatry Association president and co-author of the current paper Dr. Julius Neverauskas to learn more about the study and how it is informing, and will continue to inform, about the effect of mental distress on cognitive functioning for people experiencing myocardial infarction.

BPP: What have we known previously about the cognitive functioning and mental distress in patients with CAD?

Dr. Julius Neverauskas: First of all I would like to highlight that cognitive functioning impairment is a common finding in patients with CAD, with reported prevalence rates of 24% and 16% for mild and severe cognitive impairment. What is more, cognitive impairment in patients with CAD has been linked to elevated cardiovascular mortality risk and worse perceived health-related quality of life. Depression, anxiety, and distressed personality characteristics are common disorders that have been linked to poor outcomes, both clinical and patient-oriented (ie, directly related to patients’ experience of their illness: quality of life, morbidity, and mortality), across different populations of patients with CAD.

BPP: Why do you think it is important to study relationship between mental distress and cognitive functioning in this particular patient group?

Dr. Julius Neverauskas: I believe that studies are needed to try to connect cognitive function with distress factors such as depression and state anxiety or personality characteristics, to improve our accuracy in stratifying patients’ risk for future cognitive impairment. We also need a better understanding of which cognitive functions deteriorate soon after an acute cardiac event, to improve our early recognition of patients at risk for cognitive decline.  Correctly identified high-risk patients could benefit from early intervention and could potentially reduce their risk for cognitive decline.

BPP: What were your most excited to find? Were any findings surprising?

Dr. Julius Neverauskas:  Slow psychomotor function and information processing are cardinal features of depression and anxiety. This was exactly what we found in our study as patients with higher symptoms of depression and state anxiety were slower in psychomotor performance. The surprising finding was an association of Type D personality with worse global cognitive function and we are the first ones to document this in a scientific literature. However future research should try to elucidate behavioral and/or biological mechanisms underlying an association of personality traits with cognitive function in patients with CAD.

BPP: How does this work fit in with related past work on cognitive functioning in CAD patients?

Dr. Julius Neverauskas:  We recently published a paper in The Journal of Neuropsychiatry & Clinical Neurosciences suggesting that beta-blocker use is associated with worse cognitive performance of CAD patients. Indeed, it seems that mental distress might also play a role in this relationship.

BPP: Is there any type of cognitive training that could be offered for people with CAD?

Dr. Julius Neverauskas: It is well documented that consistent and extensive Mindfulness meditation training promotes lasting changes in cognition and well-being. New study findings suggest that even 4 days of Mindfulness training can promote benefits on a range of cognitive tasks as well as mental distress. Such training opportunities are possible in Behavioral Medicine Institute in Palanga.

BPP: What is the takeaway message you most want people to understand about this work?

Dr. Julius Neverauskas: We believe that depressive and state anxiety symptoms should be considered when interpreting the cognitive function of patients with CAD. There is also a link between Type D personality and global cognitive functioning in patients with CAD.