Cognition and coronary events: A narrative overview of neurocognitive impairment in ACS patients

Neurocognitive dysfunction is a common but often overlooked complication in patients with Acute Coronary Syndrome (ACS). This narrative review aims to provide a comprehensive synthesis of current evidence on the prevalence, mechanisms, clinical assessment, and management strategies of cognitive impairment in ACS patients. We highlight how neurocognitive deficits including memory loss, reduced attention, and executive dysfunction arise from cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. These deficits arise from mechanisms including cerebral hypoperfusion, systemic inflammation, microvascular injury, and post-infarct metabolic stress. Such impairments are associated with poorer clinical outcomes, decreased treatment adherence, and increased mortality. Routine cognitive assessment remains absent from standard ACS management, despite the availability of effective tools such as the Montreal Cognitive Assessment (MoCA), which can detect subtle cognitive deficits early in hospitalization. Integrating cognitive screening into clinical protocols enables timely interventions and better patient stratification. Management strategies should combine pharmacological treatment of cardiovascular risk factors with non-pharmacological interventions such as cognitive rehabilitation, mental health support, and lifestyle modification. Multidisciplinary collaboration between cardiology, neurology, psychology, and rehabilitation specialists is essential to address both cardiac and cognitive recovery. By integrating findings from clinical and epidemiological studies, this review underscores the need for routine cognitive screening, multidisciplinary care, and innovative interventions such as telemedicine to improve patient outcomes. Recognizing cognitive health as an integral part of ACS management offers a more holistic, patient-centered approach to recovery.