Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients

Abstract

BackgroundA number of studies have shown that COPD, particularly in its later and more severe stages, is associated with various cognitive deficits. Thus, the primary goal of the present study was to elucidate the extent of cognitive impairment in patients with long-term oxygen therapy-dependent (LTOTD) COPD. In addition, this study aimed to determine the effectiveness of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), for COPD patients and the ability of oxygen therapy to mitigate COPD-related deficits in cognitive function.MethodsThe present study enrolled 45 subjects: 24 nonuser and 21 regular-user LTOTD-COPD patients. All subjects had a similar grade of education, and there were no significant differences regarding age or sex. The MoCA (cutoff: <26 points) and MMSE (cutoff: ≤24 points) scores were compared between these two groups.ResultsThe nonuser LTOTD-COPD group had a significantly lower MoCA score than that of the regular-user LTOTD-COPD group (19.38±2.99 vs 21.68±2.14, respectively) as well as a significantly lower MMSE score. Moreover, the absence of supplemental oxygen therapy increased the risk of cognitive impairment (MoCA, P=0.007 and MMSE, P=0.014), and the MoCA and MMSE scores significantly correlated with the number of emergency admissions and the number of hospitalizations in the last year.ConclusionIn the present study, the nonuser LTOTD-COPD group exhibited a significant decrease in cognitive status compared with the regular-user LTOTD-COPD group. This suggests that the assessment of cognitive function in nonuser LTOTD-COPD patients and the use of protective strategies, such as continuous supplemental oxygen treatment, should be considered during the management of COPD in this population. In addition, the MoCA score was superior to the MMSE score for the determination of cognitive impairment in the nonuser LTOTD-COPD patients.

Neurocognitive Impairment as Systemic Effects of COPD

“…It is a recognized fact that long-term oxygen therapy (LTOT) is able to protect signiicantly (p < 0.022) the cognitive functions from COPD-induced deterioration. Another fact is that the patients with mild cognitive impairment COPD induced are unaware of the risk that involves repetitive desaturations to produce conversion from mild cognitive impairment to dementia, if nothing is done with LTOT [38,39].…”

“…(2) It is now recognized that not only continuous, but also intermitent hypoxia (eforts, daily activities and sleep) can by repetition cause changes in brain neurochemistry and structure [7,36]. Regular use of supplemental oxygen therapy has been shown to decrease the risk for cognitive impairment in patients with COPD [37,38,95].…”

The Effects of Health Education Given by Nurses to COPD Patients on the Daily Oxygen Concentrator Usage Time

“…In a similar study www.journals.viamedica.pl conducted by Nasilowski et al [12], it has been reported that FEV 1 and PaCO 2 values of patients who used OC on average for at least 15 hours daily, are better than the relevant parameters of individuals using OC less frequently. In the study conducted by Karamanlı et al [21], it has been also reported that cognitive status of COPD patients who use regularly OC is better than in those using the device irregularly [21]. At the end of our study, it was determined that if daily OC usage time is increased, clinic parameters of patients may improve.…”

Chronic Obstructive Pulmonary Disease and Extrapulmonary Effects: Cognitive Impairment

“…Many studies have shown that patients with COPD usually have cognitive impairment either globally or in certain cognitive domains. It has been reported that 42.0% of patients with COPD had moderate to severe cognitive impairment, whereas 14.0% of control subjects had cognitive dysfunction 54 . Concerning hypoxemia, the rate of neuropsychological deficit was 27.0% for mild hypoxemia but 62.0% for severe hypoxemia.…”

“…62 This suggests that cognitive function may be reversibly-impaired during exacerbation. 63 However, cognitive impairment in the patients during exacerbation has been associated with poor compliance with medication and oxygen therapy. This poor compliance increases the risk of repeated acute exacerbation.…”