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Peripheral Arterial Disease and Cognitive Function

From the Department of Psychology, University of Maryland, Baltimore County (S.R.W., C.F.T, K.J.M., J.R.P., J.S.), Baltimore, MD; and Division of Gerontology, Department of Medicine, University of Maryland School of Medicine & Geriatric Research Education and Clinical Center, Baltimore Veterans Affairs Medical Center, (S.R.W., A.W.G., R.M., L.I.K.), Baltimore, MD.

Address reprints request to: Shari R. Waldstein, PhD, Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250. Email: waldstei{at}umbc.edu

OBJECTIVE: Peripheral arterial disease (PAD) is associated with comorbid atherosclerosis of the coronary and carotid arteries and is a significant risk factor for stroke. However, cognitive function in PAD patients before clinically evident stroke remains poorly characterized. Here we hypothesized that, on neuropsychological testing, PAD patients would perform more poorly than healthy control subjects, and persons with mild cardiovascular disease (essential hypertension), but better than stroke patients, thus reflecting a continuum of cognitive impairment associated with increased severity of vascular disease.

METHOD: The cognitive performance of 38 PAD patients (mean ankle-brachial index=0.67, Fontaine Class II) was contrasted with that of 23 healthy normotensive controls, 20 essential hypertensives, and 26 anterior ischemic stroke patients on twelve neuropsychological tests.

RESULTS: PAD patients performed significantly more poorly than hypertensives and normotensives, but better than stroke patients, on seven tests of nonverbal memory, concentration, executive function, perceptuo-motor speed, and manual dexterity. Hypertensives displayed poorer performance than normotensives on tests of nonverbal memory and manual dexterity. These findings were independent of age, education, and depression scores. Higher diastolic blood pressure and plasma glucose levels predicted poorer performance of select cognitive tests by PAD patients. Eight to 67% of PAD patients displayed impaired performance (< 5^th percentile of normotensive controls) on the seven aforementioned cognitive tests.

CONCLUSIONS: PAD patients exhibit diminished performance across a variety of domains of cognitive function. Findings also suggest a continuum of cognitive impairment associated with increasingly severe manifestations of cardiovascular disease, thus emphasizing the need for enhanced preventative measures to avert functional declines.

Key Words: peripheral arterial disease, • cardiovascular disease, • hypertension, • stroke, • cognitive function, • neuropsychology.

Abbreviations: ABI = ankle-brachial index;; ANOVA = analysis of variance;; BDI = Beck Depression Inventory;; B-VAMC = Baltimore Veterans Affairs Medical Center;; DBP = diastolic blood pressure;; HSD = honestly significant difference;; MMSE = mini-mental status examination;; PAD = peripheral arterial disease;; PVD = peripheral vascular disease;; SBP = systolic blood pressure;; WMS-R = Wechsler Memory Scale-Revised.

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