认知状态对有症状外周动脉疾病患者运动能力和生活质量的影响。
Effect of cognitive status on exercise performance and quality of life in patients with symptomatic peripheral artery disease.
作者信息
Gardner Andrew W, Waldstein Shari R, Montgomery Polly S, Zhao Yan D
机构信息
Reynolds Oklahoma Center on Aging, Donald W. Reynolds Department of Geriatric Medicine, Oklahoma City, Okla.
Department of Psychology, University of Maryland Baltimore County, Baltimore, Md.
出版信息
J Vasc Surg. 2016 Jan;63(1):98-104. doi: 10.1016/j.jvs.2015.08.064. Epub 2015 Oct 23.
BACKGROUND
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 peripheral artery disease (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 with the group with the higher MMSE scores, there was a trend for lower PWT in the group with the lower MMSE scores (P = .06) after adjusting for age, sex, race, and education level (model 1), which became significant (380 ± 250 seconds vs 460 ± 270 seconds; P < .05) after adjusting for model 1 plus coronary artery disease, chronic obstructive pulmonary disease, and arthritis (model 2). Multiple domains of QoL were lower (P < .05) in the group with the lower MMSE scores 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 coronary artery disease, chronic obstructive pulmonary disease, 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 might be in greatest need of intervention to improve ambulation and QoL related to mental health.
背景
我们确定了认知筛查量表的得分是否与间歇性跛行和外周动脉疾病（PAD）患者的主要结局指标——峰值步行时间（PWT）相关，以及是否与与活动能力、社区行走、健康相关生活质量（QoL）和血管功能相关的次要结局指标相关。
方法
使用简易精神状态检查表（MMSE）问卷评估246例PAD患者的总体认知状态。患者根据MMSE得分是否为满分30分（n = 123）或是否丢失一分或更多分（n = 123）进行分组。对患者的多项结局进行了特征描述，包括跑步机测试中的PWT和QoL。
结果
在调整年龄、性别、种族和教育水平后（模型1），与MMSE得分较高的组相比，MMSE得分较低的组的PWT有降低的趋势（P = 0.06），在调整模型1加上冠状动脉疾病、慢性阻塞性肺疾病和关节炎后（模型2），这种趋势变得显著（380±250秒对460±270秒；P < 0.05）。在调整模型1后，MMSE得分较低的组的多个QoL领域较低（P < 0.05），但在进一步用模型2调整后，只有心理健康仍然较低（75±20%对80±5%；P = 0.02）。
结论
在有症状的PAD患者中，较低的认知筛查得分与比MMSE得分较高的患者更大的行走障碍相关。此外，较差的认知状态与健康相关QoL的多个维度得分较低相关，除心理健康外，所有这些都可以由冠状动脉疾病、慢性阻塞性肺疾病和关节炎的合并症来解释。临床意义在于，需要加强认知和心理健康筛查，作为有症状的PAD患者预后不良的潜在指标。此外，被确定为认知状态较差的患者可能最需要干预以改善行走和与心理健康相关的QoL。
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