Poorer clock draw test scores are associated with greater functional impairment in peripheral artery disease: The Walking and Leg Circulation Study II

Laura J. Zimmermann, Luigi Ferrucci, Liu Kiang Liu, Tian Lu Tian, Jack M. Guralnik, Michael H. Criqui, Liao Yihua Liao, Mary M. McDermott

Research output: Contribution to journalArticlepeer-review

Abstract

We hypothesized that, in the absence of clinically recognized dementia, cognitive dysfunction measured by the clock draw test (CDT) is associated with greater functional impairment in men and women with peripheral artery disease (PAD). Participants were men and women aged 60 years and older with Mini-Mental Status Examination scores ≥ 24 with PAD (n = 335) and without PAD (n = 234). We evaluated the 6-minute walk test, 4-meter walking velocity at usual and fastest pace, the Short Physical Performance Battery (SPPB), and accelerometer-measured physical activity. CDTs were scored using the Shulman system as follows: Category 1 (worst): CDT score 0-2; Category 2: CDT score 3; Category 3 (best): CDT score 4-5. Results were adjusted for age, sex, race, education, ankle-brachial index (ABI), and comorbidities. In individuals with PAD, lower CDT scores were associated with slower 4-meter usual-paced walking velocity (Category 1: 0.78 meters/second; Category 2: 0.83 meters/second; Category 3: 0.86 meters/second; p-trend = 0.025) and lower physical activity (Category 1: 420 activity units; Category 2: 677 activity units; Category 3: 701 activity units; p-trend = 0.045). Poorer CDT scores were also associated with worse functional performance in individuals without PAD (usual and fast-paced walking velocity and SPPB, p-trend = 0.022, 0.043, and 0.031, respectively). In conclusion, cognitive impairment identified with CDT is independently associated with greater functional impairment in older, dementia-free individuals with and without PAD. Longitudinal studies are necessary to explore whether baseline CDT scores and changes in CDT scores over time can predict long-term decline in functional performance in individuals with and without PAD.

Original languageEnglish (US)
Pages (from-to)173-181
Number of pages9
JournalVascular Medicine
Volume16
Issue number3
DOIs
StatePublished - Jun 2011
Externally publishedYes

Keywords

  • ankle-brachial index
  • clock draw test
  • cognitive impairment
  • functional performance
  • peripheral artery disease
  • walking

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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