Affective disorders accompanied by cognitive impairment in patients with a cardiac profile: prevalence, multimorbidity, and medical and social risk factors

Abstract

Clinical and medico-social issues of affective pathology combined with cognitive impairment in cardiac patients are a crucial problem in modern medicine. Studies have shown that 30–50% of patients with cardiovascular diseases suffer from depression and anxiety, and depressive disorders lead to disease complications and increase the mortality rate among cardiac patients. Studies based on the concept of multimorbidity show that depressive and anxiety disorders and cardiovascular diseases have common pathogenesis mechanisms: dysfunction of the hypothalamic-pituitary system, dyslipidemia, cytokine activation followed by impaired metabolism of biogenic amines, high degree and rate of platelet aggregation, and other humoral cellular mechanisms leading to dyscirculatory changes and damage to the white matter of the brain. Moreover, studies have shown an association between hypertension and chronic cerebrovascular insufficiency and increased risk of cognitive impairment. Cognitive dysfunctions in affective pathology are of great clinical and social importance; however, their initial manifestations in cardiac patients remain insufficiently diagnosed. This leads to missed opportunities for the prevention of cognitive deficits. The clinical manifestations and prognosis of multimorbid diseases are influenced by biomedical and psychosocial factors. Adverse psychosocial factors lead to clinical complications of diseases, reduce patients’ adherence to treatment, negatively affect lifestyle, disrupt social functioning, and lead to disability. Affective pathology significantly worsens social adaptation, the quality of life of patients, and the prognosis of cardiac disease and reduces adherence to treatment and does not induce a healthy lifestyle.

This review shows that it is critical to further develop the concept of multimorbidity aimed at finding common mechanisms of affective, cognitive, and cardiovascular pathology, and improving measures for the prevention and therapy of combined diseases. Full-text articles and fragments of monographs selected by keywords in the databases Scopus, Web of Science, MEDLINE, RSCI, eLIBRARY.RU, disserCat.ru, Psychiatrist, and ScienceDirect were used.

Keywords

affective disorders / cognitive dysfunction, cardiac patients / multimorbidity

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