Screening for Vascular Disease in Pulmonary Rehabilitation

Background: Several of the comorbidities and risk factors associated with COPD and other pulmonary disorders are also similar to those for lower extremity peripheral artery disease (PAD) and cerebrovascular disease. The later condition is often manifested as cognitive impairment, not only from large vessel associated stroke, but also from vascular cognitive impairment (VCI). We hypothesized that pulmonary rehabilitation (PR) would be an appropriate site to discern the prevalence of both PAD and mild cognitive impairment (MCI).Individuals in PR with severe pulmonary disease may have impaired cognition, which could impact learning and treatment adherence while PAD may contribute to functional limitation.
Study Design: In this pilot study of 14 patients enrolled in phase II PR, we describe the prevalence of PAD and cognitive impairment, the utility of screening tools, and the potential relationship between PAD, depression, and cognitive impairment.
Results: Twenty-eight percent of patients had an abnormal ABI with two subjects manifesting low (<0.90) and two subjects with abnormally high (>1.40) ABI. The Edinburgh Claudication Questionnaire was negative in all subjects and was not useful in the detection of PAD (sensitivity 0%, specificity 11%, PPV 0%, NPV 78.57%). The Walking Impairment Questionnaire did not differentiate patients with or without abnormal ABIs with respect to walking distance (40.02 vs. 64.46 meters, P=.154), speed (27.15 vs. 25.92 miles per hour, P=.545), or symptoms (46.88 vs. 63.75, P=.152). Furthermore, eleven of the fourteen patients (79%) had an overall score of less than 26 on the Montreal Cognitive Assessment, indicating cognitive impairment. Scores indicating mild to moderate depression or anxiety measured by the PHQ-9 and STAI questionnaires revealed a concurrence between depressive and anxiety symptoms.
Conclusion: Our results have leaded us to postulate a possible relationship between PAD and MCI, along with that of PAD and depression and anxiety. Future studies, with a large sample size, will provide more insight on ameliorating care for patients whose vascular disease affects cognitive function and mental health.