Waldstein Shari R, Tankard Carol F, Maier Karl J, Pelletier Jessica R, Snow Joseph, Gardner Andrew W, Macko Richard, Katzel Leslie I
Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD 21250, USA.
Psychosom Med. 2003 Sep-Oct;65(5):757-63. doi: 10.1097/01.psy.0000088581.09495.5e.
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.
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.
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.
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.
外周动脉疾病（PAD）与冠状动脉和颈动脉的共病性动脉粥样硬化相关，是中风的一个重要危险因素。然而，在临床上明显中风之前，PAD患者的认知功能仍未得到充分表征。在此，我们假设，在神经心理学测试中，PAD患者的表现会比健康对照受试者以及患有轻度心血管疾病（原发性高血压）的人更差，但比中风患者更好，从而反映出与血管疾病严重程度增加相关的认知障碍连续体。
对38名PAD患者（平均踝臂指数=0.67，Fontaine II级）的认知表现与23名健康血压正常的对照者、20名原发性高血压患者以及26名前循环缺血性中风患者进行了12项神经心理学测试对比。
在非言语记忆、注意力、执行功能、感知运动速度和手部灵活性的七项测试中，PAD患者的表现明显比高血压患者和血压正常者差，但比中风患者好。高血压患者在非言语记忆和手部灵活性测试中的表现比血压正常者差。这些发现与年龄、教育程度和抑郁评分无关。较高的舒张压和血糖水平预示着PAD患者在某些认知测试中的表现较差。在上述七项认知测试中，8%至67%的PAD患者表现受损（低于血压正常对照者的第5百分位数）。
PAD患者在各种认知功能领域的表现均有所下降。研究结果还表明，与心血管疾病日益严重的表现相关存在认知障碍连续体，从而强调需要加强预防措施以避免功能衰退。
