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Cognitive decrement in older adults with symptomatic peripheral artery disease

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Abstract

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.

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Funding

This study was supported by grants from the National Institute on Aging (R01-AG-24296, K01-AG-00657, and P60-AG12583), a General Clinical Research Center (M01-RR-14467) sponsored by the National Center for Research Resources, by a Department of Veterans Affairs GRECC, and by the University of Maryland Claude D. Pepper Older Americans Independence Center (P60-AG-12583).

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Authors and Affiliations

  1. Department of Physical Medicine & Rehabilitation, Penn State College of Medicine, 500 University Drive, Mail Code HP28, P.O. Box 850, Hershey, PA, 17033, USA

    Andrew W. Gardner & Polly S. Montgomery

  2. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Ming Wang & Biyi Shen

  3. Vascular Medicine Division, Cardiovascular Department, Mayo Clinic, Rochester, MN, USA

    Ana I. Casanegra

  4. Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Federico Silva-Palacios

  5. Vascular Cognitive Impairment and Neurodegeneration Program, Reynolds Oklahoma Center On Aging/Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Zoltan Ungvari, Andriy Yabluchanskiy & Anna Csiszar

  6. International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary

    Zoltan Ungvari, Andriy Yabluchanskiy & Anna Csiszar

  7. Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, USA

    Shari R. Waldstein

  8. Geriatric Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA

    Shari R. Waldstein

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  1. Andrew W. Gardner
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  2. Polly S. Montgomery
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  3. Ming Wang
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  4. Biyi Shen
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  5. Ana I. Casanegra
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  6. Federico Silva-Palacios
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  7. Zoltan Ungvari
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  9. Anna Csiszar
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Correspondence to Andrew W. Gardner.

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Gardner, A.W., Montgomery, P.S., Wang, M. et al. Cognitive decrement in older adults with symptomatic peripheral artery disease. GeroScience 43, 2455–2465 (2021). https://doi.org/10.1007/s11357-021-00437-8

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