Background
Despite the shared pathogenesis of peripheral arterial disease (PAD) and vascular
dementia, there are little data on cognitive impairment in PAD patients. We hypothesized
that cognitive impairment will be common and previously unrecognized.
Methods
Cognitive impairment screening was prospectively performed for veterans presenting
to a single Veterans Affairs outpatient vascular surgery clinic from 2020–2021 for
PAD consultation or disease surveillance. Overall, 125 Veterans were screened. Cognitive
impairment was defined as a score of <26 on the Montreal Cognitive Assessment (MoCA)
survey. A multivariable logistic regression assessed for independent risk factors
for cognitive impairment.
Results
Overall, 77 (61%) had cognitive impairment, 92% was previously unrecognized. Cognitive
impairment was associated with increased age (74.4 vs. 71.8 years, P = 0.03), Black versus White race (94% vs. 54%, P < 0.01), hypertension (66% vs. 31%, P = 0.01), prior stroke/TIA (79% vs. 58%, P = 0.03), diabetes treated with insulin (79% vs. 58%, P = 0.05), and post-traumatic stress disorder (PTSD) (80% vs. 57%, P = 0.04). On multivariable analysis, risk factors for newly diagnosed cognitive impairment
included age ≥70 years, diabetes treated with insulin, PTSD, and Black race.
Conclusions
Many veterans with PAD have evidence of cognitive impairment and is overwhelmingly
underdiagnosed. This study suggests cognitive impairment is an unrecognized issue
in a VA population with PAD, requiring more study to determine cognitive impairment's
impact on surgical outcomes, and how it can be mitigated and incorporated into clinical
care.
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References
- Peripheral arterial disease detection, awareness, and treatment in primary care.JAMA. 2001; 286: 1317-1324
- Patient complexity by surgical specialty does not correlate with work relative value units.Surgery. 2020; 168: 371-378
- Assessment of the risk analysis index for prediction of mortality, major complications, and length of stay in patients who underwent vascular surgery.Ann Vasc Surg. 2020; 66: 442-453
- The frailty syndrome: definition and natural history.Clin Geriatr Med. 2011; 27: 1-15
- Validation of a modified frailty index to predict mortality in vascular surgery patients.J Vasc Surg. 2016; 63: 1595-1601.e2
- Vascular cognitive impairment.Circ Res. 2017; 120: 573-591
- Vascular cognitive impairment: epidemiology, subtypes, diagnosis and management.J R Coll Physicians Edinb. 2011; 41: 49-56
- Prevalence of cognitive impairment in individuals with vascular surgical pathology: a systematic review and meta-analysis.Eur J Vasc Endovasc Surg. 2021; 61: 664-674
- Launching a geriatric surgery center: recommendations from the society for perioperative assessment and quality improvement.J Am Geriatr Soc. 2020; 68: 1941-1946
- The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- The prevalence and impact of undiagnosed cognitive impairment in older vascular surgical patients.J Vasc Surg. 2014; 60: 1002-1011.e3
- Cognitive decrement in older adults with symptomatic peripheral artery disease.Geroscience. 2021; 43: 2455-2465
- Cerebral white matter lesions and atherosclerosis in the Rotterdam Study.Lancet. 1993; 341: 1232-1237
- Cerebral white matter lesions predict both ischemic strokes and myocardial infarctions in patients with established atherosclerotic disease.Atherosclerosis. 2006; 186: 166-172
- Longitudinal changes in brain volumes and cerebrovascular lesions on MRI in patients with manifest arterial disease: the SMART-MR study.J Neurol Sci. 2014; 337: 112-118
- Associations between midlife vascular risk factors and 25-year incident dementia in the atherosclerosis risk in communities (ARIC) cohort.JAMA Neurol. 2017; 74: 1246-1254
- Brain aging in african-Americans: the atherosclerosis risk in communities (ARIC) experience.Curr Alzheimer Res. 2015; 12: 607-613
- Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication.Arch Gen Psychiatry. 2005; 62: 593-602
- Prevalence of mental health disorders in elderly U.S. Military Veterans: a meta-analysis and systematic review.Am J Geriatr Psychiatry. 2018; 26: 534-545
- Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse.J Abnorm Psychol. 2000; 109: 69-73
- Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents.J Consult Clin Psychol. 2003; 71: 692-700
- Psychological intimate partner violence: the major predictor of posttraumatic stress disorder in abused women.Neurosci Biobehav Rev. 2005; 29: 181-193
- The interplay between post-traumatic stress disorder and dementia: a systematic review.Am J Geriatr Psychiatry. 2020; 28: 48-60
- Functional outcomes after lower extremity revascularization in nursing home residents: a national cohort study.JAMA Intern Med. 2015; 175: 951-957
- Preoperative dementia is associated with increased cost and complications after vascular surgery.J Vasc Surg. 2018; 68: 1203-1208
- Social cognitive constructs and the promotion of physical activity in patients with peripheral artery disease.J Cardiopulm Rehabil Prev. 2008; 28: 65-72
- Medication adherence in older patients with dementia: a systematic literature review.J Pharm Pract. 2018; 31: 322-334
- Cognitive function is linked to adherence to bariatric postoperative guidelines.Surg Obes Relat Dis. 2013; 9: 580-585
- Cognitive function predicts 24-month weight loss success after bariatric surgery.Surg Obes Relat Dis. 2013; 9: 765-770
- Patient comprehension necessary for informed consent for vascular procedures is poor and related to frailty.J Vasc Surg. 2021; 73: 1422-1428
- Surgical “buy-in”: the contractual relationship between Surgeons and patients that influences decisions regarding life-supporting therapy.Crit Care Med. 2010; 38: 843-848
- Cognitive tests to detect dementia: a systematic review and meta-analysis.JAMA Intern Med. 2015; 175: 1450-1458
- Underestimation of cognitive impairment by mini-mental state examination versus the montreal cognitive assessment in patients with transient ischemic attack and stroke.Stroke. 2010; 41: 1290-1293
Article info
Publication history
Published online: December 26, 2022
Accepted:
November 27,
2022
Received:
April 20,
2022
Footnotes
Note to the Editor: An abstract of this work was presented at the Vascular and Endovascular Surgical Society Annual Meeting in Snowmass, CO January 27th–January 30th, 2022.
Identification
Copyright
© 2022 Published by Elsevier Inc.
