Cognitive function in patients with peripheral artery disease: a prospective single-center cohort study

AIM The aim of the present study was to examine the association between cardiovascular comorbidities and risk factors, and cognitive function in PAD patients and to determine the influence of cognitive function on cardiovascular outcome in a two--year follow--up. METHODS The cognitive function of 104 PAD patients was assessed using the mini--mental test (MMSE). Ankle brachial index (ABI), Fontaine stage, PAD localisation, cardiovascular risk factors and comorbidities were taken from the electronic patient charts. A multiple logistic regression model, which included MI, stroke/TIA, DM, CHD and smoking was performed to compare patients with and without cognitive impairment. All study participants were followed for two years in order to evaluate their cardiovascular outcome, mortality and revascularisation rate. RESULTS There was no significant difference in mini--mental state between asymptomatic and symptomatic PAD patients. ABI and PAD localisation was not related to cognitive function. However, pre--existing stroke, transient ischemic attack, coronary artery disease (CAD) or diabetes mellitus were associated with a lower mini--mental test score. When MMSE was dichotomized in ≤ 27 and >27 points, the presence of coronary artery disease, history of cerebrovascular events and diabetes mellitus was associated with a MMSE ≤ 27 in multivariate analysis There was no association between MMSE and cardiovascular event rate. CONCLUSION PAD patients with coronary artery disease, stroke, transient ischemic attack or diabetes mellitus have worse cognitive function than those without these factors. There was no evidence that cognitive function influenced cardiovascular outcome

Cognitive function in patients with peripheral artery disease: a prospective single-center cohort study

AIM The aim of the present study was to examine the association between cardiovascular comorbidities and risk factors, and cognitive function in PAD patients and to determine the influence of cognitive function on cardiovascular outcome in a two--year follow--up. METHODS The cognitive function of 104 PAD patients was assessed using the mini--mental test (MMSE). Ankle brachial index (ABI), Fontaine stage, PAD localisation, cardiovascular risk factors and comorbidities were taken from the electronic patient charts. A multiple logistic regression model, which included MI, stroke/TIA, DM, CHD and smoking was performed to compare patients with and without cognitive impairment. All study participants were followed for two years in order to evaluate their cardiovascular outcome, mortality and revascularisation rate. RESULTS There was no significant difference in mini--mental state between asymptomatic and symptomatic PAD patients. ABI and PAD localisation was not related to cognitive function. However, pre--existing stroke, transient ischemic attack, coronary artery disease (CAD) or diabetes mellitus were associated with a lower mini--mental test score. When MMSE was dichotomized in ≤ 27 and >27 points, the presence of coronary artery disease, history of cerebrovascular events and diabetes mellitus was associated with a MMSE ≤ 27 in multivariate analysis There was no association between MMSE and cardiovascular event rate. CONCLUSION PAD patients with coronary artery disease, stroke, transient ischemic attack or diabetes mellitus have worse cognitive function than those without these factors. There was no evidence that cognitive function influenced cardiovascular outcome

Predictive value of auscultation of femoropopliteal arteries

BACKGROUND: Femoropopliteal bruits indicate flow turbulences and increased blood flow velocity, usually caused by an atherosclerotic plaque or stenosis. No data exist on the quality of bruits as a means for quantifying the degree of stenosis. We therefore conducted a prospective observational study to investigate the sensitivity and specificity of femoropopliteal auscultation, differentiated on the basis of bruit quality, to detect and quantify clinically relevant stenoses in patients with symptomatic and asymptomatic peripheral arterial disease (PAD). METHODS: Patients with known chronic and stable PAD were recruited in the outpatient clinic. We included patients with known PAD and an ankle-brachial index (ABI) <0.90 and/or an ABI ≥0.90 with a history of lower limb revascularisation. Auscultation was performed independently by three investigators with varied clinical experience after a 10-minute period of rest. Femoropopliteal lesions were classified as follows: normal vessel wall or slight wall thickening (<20%), atherosclerotic plaque with below 50% reduction of the vessel lumen, prestenotic/intrastenotic ratio over 2.5 (<70%), over 3.5 (<99%) and complete occlusion (100%). RESULTS: Weighted Cohen's κ coefficients for differentiated auscultation were low in all vascular regions and did not differ between investigators. Sensitivity was low in most areas with an increase after exercise. The highest sensitivity in detecting relevant (>50%) stenosis was found in the common femoral artery (86%). CONCLUSION: Vascular auscultation is known to be of great use in routine clinical practice in recognising arterial abnormalities. Diagnosis of PAD is based on various diagnostic tools (pulse palpation, ABI measurement) and auscultation can localise relevant stenosis. However, auscultation alone is of limited sensitivity and specificity in grading stenosis in femoropopliteal arteries. Where PAD is clinically suspected further diagnostic tools, especially colour-coded duplex ultrasound, should be employed to quantify the underlying lesion

Increased permeability of cutaneous lymphatic capillaries and enhanced blood flow in psoriatic plaques

Morphological abnormalities of microvessels are described in psoriasis. However, there are conflicting data as to whether their function is also altered.; Our aim was to study the morphology and function of the lymphatic capillaries of psoriatic skin.; Morphology and permeability of initial lymphatics were studied by microlymphography and densitometry in 20 patients. Perfusion was studied by laser Doppler fluxmetry.; Permeability of lymphatics in plaques was increased by 7.6% compared to unafflicted skin (p < 0.001). Lymphatic vessel density and the extension of dye in lymphatic networks were not significantly different between involved and uninvolved areas. Both sites showed a wide range of diameters of lymphatics. The median laser Doppler flux in plaques was increased by 144% (91-380%) compared to unaffected skin (p < 0.001).; Increased permeability of lymphatics and increased blood flow was demonstrated in vivo in psoriatic skin lesions. These findings may reflect the local inflammatory process and may be used as markers when studying new therapeutic approaches for psoriasis