Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort.

Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.

Hypervigilance during anxiety and selective attention during fear: Using steady-state visual evoked potentials (ssVEPs) to disentangle attention mechanisms during predictable and unpredictable threat.

Anxiety is induced by unpredictable threat, and presumably characterized by enhanced vigilance. In contrast, fear is elicited by imminent threat, and leads to phasic responses with selective attention. In order to investigate attention mechanisms and defensive responding during fear and anxiety, we employed an adaptation of the NPU-threat test and measured cortical (steady-state visual evoked potentials, ssVEPs), physiological (heart rate, HR), and subjective responses (ratings) to predictable (fear-related) and unpredictable (anxiety-related) threat in 42 healthy participants. An aversive unconditioned stimulus (US, loud noise) was 100% predicted by a cue (predictable P-cue) in one context (predictable P-context), but appeared unpredictably within a different context (unpredictable U-context, U-cue), while it was never delivered in a neutral safe context (N-cue, N- context). In response to predictable threat (P-cue), increased ssVEP amplitudes and accelerated HR were found. Both predictable and unpredictable contexts yielded increased ssVEP amplitudes compared to the safe context. Interestingly, in the unpredictable context participants showed longer-lasting visuocortical activation than in the predictable context, supporting the notion of heightened vigilance during anxiety. In parallel, HR decelerated to both threat contexts indicating fear bradycardia to these threatening contexts as compared to the safe context. These results support the idea of hypervigilance in anxiety-like situations reflected in a long-lasting facilitated processing of sensory information, in contrast to increased selective attention to specific imminent threat during fear. Thus, this study further supports the defense-cascade model with vigilance and orienting in the post-encounter phase of threat (anxiety), while selective attention and defensive mobilization in the circa-strike phase of threat (fear).