Clinical characteristics and risk factors of cognitive impairment in coronary atherosclerotic heart disease patients of different ages

Ying Xiao; Zheng Wen; Cui Yonghui; Kan Yawen; Li Jing; Liu Yu; Zeng Yong

doi:10.3760/j.issn.1673-4777.2026.01.001

Abstract：Objective To explore the clinical characteristics and risk factors of cognitive impairment in coronary atherosclerotic heart disease(CHD)patients of different age groups.Methods A prospective cohort study was conducted,enrolling a total of 9 893 CHD patients who visited Beijing Anzhen Hospital,Capital Medical University from December 2021 to April 2023.The patients were divided into middle-aged group(45-59 years old,4 121 cases)and elderly group(≥60 years old,5 772 cases)according to age.Cognitive function was assessed using the mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA).Sleep quality was evaluated by the pittsburgh sleep quality index(PSQI),and anxiety and depression status were assessed with the self-rating anxiety scale(SAS)and self-rating depression scale(SDS),respectively.Multivariate Logistic regression analysis was used to identify the risk factors for cognitive impairment in CHD patients.Results The prevalence of cognitive impairment in the middle-aged group was lower than that in the elderly group[33.9％(1 396/4 121)vs 55.6％(3 210/5 772)](P＜0.001).The proportion of poor sleep quality in the middle-aged group was lower than that in the elderly group(P＜0.001).There were no statistically significant differences in SAS and SDS scores between the middle-aged and elderly groups(both P＞0.05).The results of multivariate Logistic regression analysis showed that advanced age,female gender,cerebral infarction,myocardial infarction,poor sleep quality,anxiety,and depression were significantly associated with an increased risk of cognitive impairment(all P＜0.05).Subgroup analysis by age revealed that in the middle-aged group,female gender,diabetes mellitus,cerebral infarction,myocardial infarction,poor sleep quality,and depression were independent risk factors for cognitive impairment;in the elderly group,female gender,cerebral infarction,myocardial infarction,poor sleep quality,anxiety,and depression were independent risk factors for cognitive impairment(all P＜0.05).Conclusion The prevalence of cognitive impairment is relatively high in patients with CHD.Advanced age,cerebral infarction,myocardial infarction,insomnia,anxiety,and depression can exacerbate cognitive impairment in CHD patients.Approximately one-third of middle-aged CHD patients have cognitive impairment,and their risk factors differ from those of elderly patients.Diabetes mellitus can increase the severity of cognitive impairment in middle-aged patients but has no significant effect on elderly patients;anxiety is not a risk factor for cognitive impairment in middle-aged patients but can significantly increase the risk in elderly patients.