Peripheral artery disease (PAD) is highly prevalent, affecting up to 20% of people over 70 years of age. To test the hypothesis that PAD promotes the pathogenesis of vascular cognitive impairment (VCI), we compared cognitive function in older adults with symptomatic PAD and in participants without PAD who had a burden of comorbid conditions. Furthermore, we compared the cognitive function of these groups after adjusting for demographic and clinical characteristics, comorbid conditions, and cardiovascular risk factors. Participants with PAD (age: 69 ± 8 years; n = 58) and those without PAD (age: 62 ± 8 years; n = 30) were assessed on a battery of eight neuropsychological tests. The tests assessed attention and working memory, verbal memory, non-verbal memory, perceptuo-motor speed, and executive function. Participants were further characterized on demographic and clinical characteristics, comorbid conditions, cardiovascular risk factors, and ankle-brachial index. The PAD group had significantly lower neuropsychological scores than the non-PAD control group on all eight tests (P < .01). After adjusting for covariates, significantly worse scores in the PAD group persisted for verbal memory, measured by tests on logical memory-immediate recall (P = .022), and logical memory-delayed recall (P < .001), and for attention and working memory, measured by tests on digits forward (P < .001), and digits backward (P = .003). Participants with symptomatic PAD have substantially lower levels of performance on tests of attention, working memory, and verbal memory than participants without PAD independent of demographic characteristics and comorbid health burdens. These findings provide additional evidence in support of the concept that generalized accelerated vascular aging manifesting as symptomatic PAD in the peripheral circulation also affects the brain promoting the pathogenesis of VCI. These cognitive difficulties may also negatively impact symptomatic patient’s ability to understand and adhere to behavioral and medical therapies, creating a vicious cycle. We speculate that more intensive follow-up may be needed to promote adherence to therapies and monitor cognitive decline that may affect care.

外周动脉疾病 (PAD) 非常普遍，影响 70 岁以上人群的比例高达 20%。为了检验 PAD 促进血管性认知障碍 (VCI) 发病机制的假设，我们比较了患有 PAD 症状的老年人和有共病负担的无 PAD 参与者的认知功能。此外，我们在调整人口和临床特征、合并症和心血管危险因素后比较了这些群体的认知功能。对患有 PAD 的参与者（年龄：69 ± 8 岁；n  = 58）和没有 PAD 的参与者（年龄：62 ± 8 岁；n  = 30）进行了八项神经心理学测试的评估。这些测试评估了注意力和工作记忆、语言记忆、非语言记忆、感知运动速度和执行功能。对参与者的人口统计学和临床​​特征、合并症、心血管危险因素和踝臂指数进行了进一步的表征。在所有八项测试中，PAD 组的神经心理学评分均显着低于非 PAD 对照组 ( P  < .01)。调整协变量后，PAD 组在语言记忆方面的得分仍然明显较差，通过逻辑记忆立即回忆 ( P  = .022) 和逻辑记忆延迟回忆 ( P  < .001) 测试以及注意力和注意力测试来衡量工作记忆，通过数字向前 ( P  < .001) 和数字向后 ( P  = .003)测试来测量。与没有 PAD 的参与者相比，患有 PAD 症状的参与者在注意力、工作记忆和言语记忆测试中的表现水平明显较低，与人口特征和共病健康负担无关。这些发现提供了额外的证据来支持这一概念，即外周循环中表现为症状性 PAD 的全身血管加速老化也会影响大脑，从而促进 VCI 的发病机制。这些认知困难还可能对有症状的患者理解和坚持行为和药物治疗的能力产生负面影响，从而形成恶性循环。我们推测可能需要更深入的随访以促进对治疗的依从性并监测可能影响护理的认知能力下降。