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A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Association Between Endothelial Function and Cognitive Performance in Patients With Coronary Artery Disease During
Mahwesh Saleem1, Nathan Herrmann, Adam Dinoff
1From the Neuropsychopharmacology Research Group (Saleem, Herrmann, Dinoff, Mazereeuw, Lanctôt), Sunnybrook Health Sciences Centre; Departments of Pharmacology and Toxicology (Saleem, Dinoff, Mazereeuw, Goldstein, Lanctôt) and Psychiatry (Herrmann, Goldstein, Lanctôt), University of Toronto, Toronto, Canada; Division of Clinical Pharmacology (Oh), Sunnybrook Health Sciences Centre; Toronto Rehabilitation Institute (Oh, Lanctôt), Toronto, Canada; Evaluative Clinical Sciences (Kiss), Hurvitz Brain Sciences Program, Sunnybrook Research Institute; Department of Health Policy (Kiss), University of Toronto, Toronto, Canada; and Neuropsychology (Shammi), Sunnybrook Health Sciences Centre, Toronto, Canada.
Insights
Endothelial function, measured by reactive hyperemia index (RHI), predicts cognitive improvements in coronary artery disease (CAD) patients undergoing cardiac rehabilitation. Improved RHI is linked to better cognitive outcomes, suggesting its role in neural adaptation.
Area of Science:
- Cardiology
- Neuroscience
- Vascular Biology
Background:
- Coronary artery disease (CAD) is associated with subtle cognitive deficits, indicating early neural risk.
- Cognitive decline in CAD patients may be influenced by vasculopathy and endothelial dysfunction.
- The heterogeneous response to exercise in CAD patients highlights the need to understand underlying physiological mechanisms.
Purpose of the Study:
- To investigate peripheral endothelial function as a predictor of cognitive performance in CAD patients undergoing cardiac rehabilitation (CR).
- To assess the association between the reactive hyperemia index (RHI) and cognitive changes over a 3-month CR program.
Main Methods:
- A prospective observational study included 64 CAD patients undergoing CR.
- Neuropsychological and endothelial function (RHI) assessments were conducted at baseline and after 3 months.
- Linear regressions and mixed models were used to analyze cross-sectional and longitudinal associations between RHI and cognitive performance.
Main Results:
- While baseline RHI was not associated with overall cognition, an increased RHI over 3 months significantly predicted overall cognitive improvement (b = 0.55, p = .030).
- Lower baseline RHI correlated with poorer verbal memory (β = 0.28, p = .027).
- An increased RHI during CR was associated with improved processing speed (b = 0.42, p = .033).
Conclusions:
- The reactive hyperemia index (RHI) shows potential as a clinical predictor of cognitive change in CAD patients.
- RHI measurements may offer insights into the mechanisms underlying cognitive dysfunction in coronary artery disease.
- Endothelial function is a key factor in cognitive adaptation during cardiac rehabilitation for CAD patients.
Objective:
Subtle cognitive deficits indicating early neural risk are common in the clinical presentation of coronary artery disease (CAD). Although deterioration may be mitigated by exercise, cognitive response to exercise is heterogeneous. Vasculopathy including endothelial dysfunction is a hallmark of CAD and may play an important role in impairing neural adaptation to exercise. This study aimed to assess peripheral measurements of endothelial function as predictors of cognitive performance in CAD participants undertaking cardiac rehabilitation (CR).
Methods:
CAD patients (N = 64) undergoing CR were recruited for this prospective observational study. Neuropsychological and endothelial function assessments were performed at baseline and after 3 months of CR. Z-scores for overall cognitive performance and specific cognitive domains (verbal and visuospatial memory, processing speed, and executive function) were calculated. Endothelial function was measured by the reactive hyperemia index (RHI) using peripheral arterial tonometry. Cross-sectional and longitudinal associations between RHI and overall cognition were assessed using linear regressions and mixed models, respectively. Domain-specific associations were also explored.
Results:
Although lower RHI was not associated with overall cognition at baseline (b = 0.26, p = .10), an increased RHI was significantly associated with an improvement in overall cognition (b = 0.55, p = .030) over 3 months. Lower RHI was associated with poorer verbal memory (β = 0.28, p = .027) at baseline and an increased RHI over 3 months was associated with an improvement in processing speed (b = 0.42, p = .033).
Conclusions:
RHI may be a clinically useful predictor of cognitive change and might provide insight into the etiology of cognitive dysfunction in patients with CAD.
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