Undiagnosed Dementia in Patients with Peripheral Arterial Disease: A Systematic Review of The Literature

Introduction: It is purported that patients with peripheral arterial disease (PAD) may have impaired cognitive function due to concomitant cerebrovascular disease. Such disease may be clinically unrecognized but can impact on a patients recovery and prognosis. The purpose of this systematic review was to interrogate the body of published evidence on undiagnosed dementia in PAD patients. Methods: A search strategy encompassing MEDLINE, Scopus, and the Cochrane database was developed to identify peer-reviewed articles examining rates of undiagnosed dementia in patients with PAD. The following search terms were used: `PAD; `PVD; `dementia; peripheral arterial disease ; peripheral vascular disease; cognitive impairment;alzheimers disease and `cogniti. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines were followed throughout. Our primary outcome was the incidence of previously undiagnosed dementia in patients with PAD. Results: The initial literature search yielded 1492 titles. After removal of duplicates, 994 abstracts were screened to ascertain if they were potentially eligible for inclusion. Abstract review yielded 62 full texts for further evaluation and from this 8 case-control studies consisting of 1161 patients were included in the review. Analysis of these studies revealed that PAD patients performed significantly worse than controls on a variety of neuropsychological measures of executive function (6 out of 8 studies). Conclusion: Our review indicated that PAD patients are more likely to suffer with undiagnosed dementia than healthy controls. This condition may impact on their ability to comply with treatment strategies and should be bourne in mind when managing this challenging patient cohort