Association of Depression, Anxiety, and Type D Personality with Cognitive Function in Patients with Coronary Artery Disease Julius Burkauskas, MSc,* Julija Brozaitiene, MD, PhD,* Adomas Bunevicius, MD, PhD,w Julius Neverauskas, MD, PhD,* Violeta Zaliunaite, PhD,* and Robertas Bunevicius, MD, PhD* 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 frac- tion, we found that higher depression symptom scores correlated with longer Digit Symbol Test completion time (b = 0.158, P < 0.004). Higher state anxiety scores correlated with worse Digit Span Test backward recall (b =  0.117, P < 0.008) and Trail Making Test Part A scores (b = 0.182, P < 0.004). Type D personality correlated with lower Mini-Mental State Examina- tion scores (b =  0.148, P = 0.001). Conclusions: For patients with CAD undergoing a cardiac re- habilitation program, depression, anxiety, and Type D person- ality were associated with worse cognitive performance independent of clinical CAD severity and sociodemographic characteristics. Key Words: cognition, coronary artery disease, depression, anxiety, Type D personality (Cogn Behav Neurol 2016;29:91–99) BDI-II = Beck Depression Inventory-II. CABG = coronary ar- tery bypass graft. CAD = coronary artery disease. DS14 = 14- item Type D Scale. LVEF = left ventricular ejection fraction. MMSE = Mini-Mental State Examination. NYHA = New York Heart Association. STAI (-S, -T) = State-Trait Anxiety Inventory (-state, -trait). We dedicate this article to the memory of senior author Robertas Bunevicius, whose untimely death during the preparation of this article has deprived us of a great colleague, inspiring collaborator, and mentor. C oronary artery disease (CAD) remains the leading cause of death in developed countries (Eurostat, 2011). Together with cerebrovascular disorders, CAD accounted for one fifth of all deaths in 2010 in Europe (Organisation for Economic Co-operation and Develop- ment, 2012). Cognitive impairment is a common finding in pa- tients with CAD, with reported point prevalence rates of 24% and 16% for mild and severe cognitive impairment, respectively (Haring et al, 2013). Cognitive impairment in patients with CAD has been linked to elevated car- diovascular mortality risk (Fried et al, 1998) and worse perceived health-related quality of life (Kiessling and Henriksson, 2004). Several clinical factors, particularly a history of coronary artery bypass graft (CABG) surgery (Selnes et al, 2004) or stroke (Rasquin et al, 2013; Wolf and Rognstad, 2013), have been linked to cognitive de- terioration in patients with CAD. Studies to identify factors affecting the cognitive function of patients with CAD are needed to help us better identify those patients at high risk for cognitive decline (Eggermont et al, 2012). Depression, state and trait anxiety, and distressed personality characteristics are common disorders that have been linked to poor outcomes, both clinical and Received for publication March 5, 2015; accepted February 28, 2016. From the *Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania; and wLaboratory of Clinical Research, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania. Supported in part by the European Social Fund under the Global Grant measure VP1-3.1-SMM-07-K-02-060. The authors declare no conflicts of interest. Reprints: Julius Burkauskas, MSc, Behavioral Medicine Institute, Lithuanian University of Health Sciences, Vyduno 4, Palanga LT00135, Lithuania (e-mail: julius.burkauskas@lsmuni.lt). Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved. ORIGINAL STUDY Cogn Behav Neurol  Volume 29, Number 2, June 2016 www.cogbehavneurol.com | 91 Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved.