Association of Depression, Anxiety, and Type D Personality with Cognitive Function in Patients with Coronary Artery Disease

Background and Objective: Cognitive impairment predicts poor outcomes in patients with coronary artery disease (CAD), but much remains to be learned about these patients' cognitive function. We investigated 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. Methods: We evaluated 510 consecutive patients with CAD (364 men, 146 women; mean age 58 +/- 9 years) but no history of coronary artery bypass graft surgery or cognitive impairment who were attending a cardiac rehabilitation program. We assessed the patients' cognitive function (Mini-Mental State Examination, Digit Span Test, Digit Symbol Test, and Trail Making Test Part A), depressive symptoms (Beck Depression Inventory-II), anxiety (State-Trait Anxiety Inventory), Type D personality (14-item Type D Scale), and clinical markers of CAD severity. Results: After adjusting for sex, age, education, New York Heart Association functional class, and left ventricular ejection fraction, we found that higher depression symptom scores correlated with longer Digit Symbol Test completion time (beta = 0.158, P < 0.004). Higher state anxiety scores correlated with worse Digit Span Test backward recall (beta = -0.117, P < 0.008) and Trail Making Test Part A scores (beta = 0.182, P < 0.004). Type D personality correlated with lower Mini-Mental State Examination scores (beta = -0.148, P = 0.001). Conclusions: For patients with CAD undergoing a cardiac rehabilitation program, depression, anxiety, and Type D personality were associated with worse cognitive performance independent of clinical CAD severity and sociodemographic characteristics.