Affective disorders accompanied by cognitive disorders in inpatients with cardiovascular diseases: a clinical and pathopsychological study

BACKGROUND: The multimorbidity of affective, cognitive, and cardiovascular diseases is an urgent issue of the contemporary medicine due to their severity, resistance to therapy, social maladjustment, and low quality of life. Common pathogenetic mechanisms, including endothelial dysfunction and disorders of the frontal and subcortical connections, enhance these conditions, increasing the risks of dementia and mortality.

AIM: To study the clinical and psychopathological structure of affective disorders and comorbid cognitive disorders in inpatients with cardiovascular diseases in various age groups.

METHODS: An observational, single-center study was conducted from January 2023 to June 2024 at the University Clinic of the Russian University of Medicine. The study involved 121 patients with cardiovascular diseases and non-psychotic mental disorders, including 47 (38.8%) with comorbid affective and cognitive disorders. The patients were divided into three age groups, 45–59, 60–74, and 75–90 years. Clinical psychopathological and psychometric (Hospital Anxiety and Depression Scale, Montreal Cognitive Assessment) and neuropsychological methods (clock drawing test, Luria’s method) were used. Statistical analysis was performed using Fisher’s exact test and Student’s t-test.

RESULTS: In 85.1% of patients, we detected organic emotional disorders, mainly with alarming symptoms. Significant differences in the clinical structure of affective disorders between the groups indicate age-related differences (p = 0.045). Cognitive disorders (visual and constructional praxis, attention, memory, abstract thinking) are associated with vascular changes and dysfunction of the frontal lobes. The Montreal Cognitive Assessment scores were in the range of 18–27; the average score in the 45–59 group (24.9 ± 0.3) was higher compared to the 60–74 (23.5 ± 0.2; p < 0.05) and 75–90 groups (23.4 ± 0.3; p < 0.05). Moderate cognitive disorders were detected in 55.3% of cases, severe cognitive disorders were detected in 19.2% of cases, and 25.5% of cases were within the normal range. Subjective cognitive complaints related to the risk of dementia were not confirmed by tests in 27.6% of cases. Attention and abstract thinking disorders increased with age (p < 0.05); whereas speech disorders showed no significant differences (p > 0.05).

CONCLUSION: The study highlights the importance of early diagnosis and an interdisciplinary approach to multimorbid conditions and a qualitative analysis of the psychopathological and pathopsychological structure of affective and cognitive disorders in cardiovascular cases. The limitation is the small sample size, requiring further research on a larger sample of patients.