Effect of cognitive status on exercise performance and quality of life in patients with symptomatic peripheral artery disease

Abstract

Purpose We determined whether scores on a cognitive screening measure were associated with the primary outcome measure of peak walking time (PWT) and with secondary outcome measures related to mobility, community-based ambulation, health-related quality of life (QoL), and vascular function in patients with claudication and PAD. Methods Gross cognitive status of 246 PAD patients was assessed with the Mini-Mental State Examination (MMSE) questionnaire. Patients were grouped according to whether they had a perfect MMSE score of 30 points (n=123) or whether they missed one or more points (n=123). Patients were characterized on numerous outcomes, including PWT during a treadmill test and QoL. Results Compared to the Higher MMSE group, there was a trend for lower PWT in the Lower MMSE group (p=.06) after adjusting for age, sex, race, and education level (model 1), which became significant (380±250 s vs. 460±270 s, p<.05) after adjusting for model 1 plus coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and arthritis (model 2). Multiple domains of QoL were lower (p<.05) in the Lower MMSE group after adjusting for model 1, but only mental health remained lower (75±20% vs. 80±5%, p=.02) after further adjustment with model 2. Conclusions In symptomatic patients with PAD, lower cognitive screening scores were associated with greater ambulatory impairment than in patients with higher MMSE scores. Furthermore, worse cognitive status was associated with lower scores in multiple dimensions of health-related QoL, all of which except mental health were explained by the comorbid conditions of CAD, COPD, and arthritis. The clinical significance is that there is a need for enhanced cognitive and mental health screening as potential indicators of poor outcome among symptomatic patients with PAD. Furthermore, patients identified as having worse cognitive status may be in greatest need of intervention to improve ambulation and quality of life related to mental health.

Predictors of health-related quality of life in patients with symptomatic peripheral artery disease

“…We have previously found that metabolic syndrome 21 and lower cognitive status 22 are both negatively associated with HRQoL in symptomatic patients with PAD, and another investigation found that hypertension is negatively associated with overall quality of life and general health. 18 However, the identification of factors associated with baseline HRQoL in symptomatic patients with PAD has been primarily limited to PAD-specific markers, and has rarely considered comorbid conditions, 18 patient-based measures of overall physical function, and objective measurements of physical activity level.…”

Beneficial Effect of Exercise on Cognitive Function during Peripheral Arterial Disease: Potential Involvement of Myokines and Microglial Anti-Inflammatory Phenotype Enhancement

“…Recently, confirming experimental data, clinical trials have shown the presence of cerebrovascular disease in the context of PAD [26,27,28,29]. Thus, compared to hypertensives and normotensives patients, patients with PAD had significantly lower performance on seven tests of nonverbal memory, concentration, executive function, perception-motor speed, and manual dexterity.…”

“…In a study conducted by Gardner et al [28], patients with PAD were grouped according to their performance on a mini-mental state examination (MMSE). Patients who scored at least 28 out of 30 points on MMSE underwent an assessment of several aspects, including peak walking time and health-related quality of life.…”

Cognitive, psychological and social factors associated with older adults' mobility: a scoping review of self‐report and performance‐based measures

“…The majority ( n = 129, 70.5%) of the included studies' populations were older adults with no defined conditions. The remaining 54 articles (29.5%) included older adults with dementia or cognitive impairment, 34–59 fragile X syndrome associated with tremor/ataxia, a condition resulting from a gene permutation, 60 stroke, 61,62 chronic obstructive pulmonary disease, 63 cancer, 64,65 diabetes, 66 Parkinson's disease, 17,67–74 cardiovascular disease, 14,75–80 lower back pain, 81 multiple comorbidities 82–84 and post‐menopausal conditions 85 . Most studies recruited participants from the community ( n = 164, 89.6%), and the remaining studies ( n = 19, 10.4%) recruited from the hospital and long‐term care setting or both the long‐term care and community setting, or did not report the setting from which the participants were recruited.…”