Cognitive impairment in chronic obstructive pulmonary disease

Incalzi, Raffaele Antonelli; Marra, Camillo; Giordano, Alessandro; Calcagni, Maria Lucia; Cappa, Antonella; Basso, Salvatore; Pagliari, Gabriella; Fuso, Leonello

doi:10.1007/s00415-003-1005-4

Cited by 139 publications

(88 citation statements)

References 33 publications

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“…Research on cognitive function assessed by single-photon-emission computed tomography in subjects with COPD indicated that worsening of hypoxemia may be associated with frontal-type cognitive decline. 31 However, current evidence would suggest that hypoxemia alone is not enough to account for the cognitive impairment in COPD. 14 Depressive symptoms in the subjects with bronchiectasis may be an important determinant for low cognitive ability in the present study.…”

Section: Discussionmentioning

confidence: 99%

Low Cognitive Ability in Subjects With Bronchiectasis

Gülhan¹,

Bulcun²,

Gülhan

et al. 2015

Respir Care

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BACKGROUND: Bronchiectasis may change cognitive function. The mechanism responsible for cognitive dysfunction in COPD may be neuronal damage caused by hypoxia. Cognitive function in patients with bronchiectasis is also likely to be affected by similar mechanisms. The goal of this study was to determine the frequency and determinants of low cognitive ability in subjects with stable bronchiectasis. METHODS: Thirty subjects with stable bronchiectasis and 25 healthy volunteers underwent a cognitive ability assessment using the Wechsler Adult Intelligence Scale. Bronchiectasis was diagnosed by high-resolution computed tomography of the chest. Age, body mass index, the Hospital Anxiety and Depression Scale, and pulmonary function were assessed. Perceived intensity of dyspnea after exercise (after climbing 3 flights of stairs) was estimated using a modified Borg scale. RESULTS: Mean scores on the verbal and performance tests and full-scale IQ scores were significantly lower in subjects with bronchiectasis than in healthy volunteers. Low cognitive ability in subjects with bronchiectasis was associated with higher depression scores, lower oxygen saturation, and poor lung function after adjusting for potential confounders in multivariate analysis. Borg scores after exercise in subjects with bronchiectasis and low cognitive ability were higher than those in subjects with bronchiectasis and high cognitive ability, despite similar P aO 2 and FEV 1 in both groups. CONCLUSIONS: Low cognitive ability in subjects with bronchiectasis may be associated with reduced lung function, more serious hypoxemia, and higher depressive symptoms. Subjects with bronchiectasis and low cognitive ability feel more intense dyspnea than do those with high cognitive ability.

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Section: Discussionmentioning

confidence: 99%

Low Cognitive Ability in Subjects With Bronchiectasis

Gülhan¹,

Bulcun²,

Gülhan

et al. 2015

Respir Care

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“…Some studies have proposed that intermittent and continuous hypoxia in COPD patients, which results from poor lung function, may lead to transient deficits in the metabolism of neurotransmitters in the central nervous system [29,30,31,32]. Other studies have suggested that in the late stage of the disease, as a consequence of decreased pulmonary function, cerebral blood perfusion is reduced, which may exacerbate ischemia in some brain regions and thus may increase subcortical atrophy [7,33]. …”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that COPD patients exhibit earlier cognitive decline in age and health status than expected [5,6]. However, the mechanisms involved in the impairment of cognition and the relevant factors are complex and not fully understood [7,8]. …”

Section: Introductionmentioning

confidence: 99%

The Evaluation of Cognitive Impairment and Relevant Factors in Patients with Chronic Obstructive Pulmonary Disease

Huang

Zhang³

2012

Respiration

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Background: Chronic obstructive pulmonary disease (COPD) is understood to be a complex multicomponent disorder. The impairment of cognition is lasting and profound. However, the pattern of the cognitive decline and potentially adverse factors are poorly understood. Objectives: To evaluate the cognitive performances and the relevant factors in COPD patients and to investigate the relationship between cognition deficits and the classification of severity of the disease. Methods: Twenty-seven mild-to-moderate COPD patients, 35 severe COPD patients and 27 control subjects were recruited. Cognitive states were investigated by the Mini-Mental State Examination (MMSE). Pulmonary function, arterial blood gas and serum clusterin level were evaluated in each subject. Results: Lower MMSE score and higher serum clusterin concentration were observed in mild-to-moderate COPD patients, while the lowest MMSE score and the highest serum clusterin level were found in severe COPD patients when compared with control subjects. MMSE score is positively correlated with arterial oxygen tension and is inversely associated with serum clusterin level in both mild-to-moderate and severe COPD patients. Furthermore, MMSE scores and serum clusterin concentrations were correlated with forced expiratory volume in 1 s in severe COPD patients. Conclusion: Cognitive impairment was found in COPD patients. It is associated with the classification of disease severity, hypoxemia and serum clusterin level. An increased serum clusterin level may be a relevant peripheral biomarker of cognitive dysfunction in COPD patients.

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“…The diagnosis of COPD was made according to the American Thoracic Society standards [12] . Only patients with PaO 2 ^56 mm Hg either at rest or at the end of the 6-min walking test while breathing room air were selected because cognitive impairment is highly prevalent in hypoxemic COPD patients [10,13] . Probable Alzheimer's disease or other conditions, such as cerebrovascular disease or hypothyroidism, and drugs apt to affect the cognitive status [14,15] were criteria of exclusion from the study.…”

Section: Methodsmentioning

confidence: 99%

Screening of Cognitive Impairment in Chronic Obstructive Pulmonary Disease

Incalzi

Corsonello

Trojano

et al. 2007

Dement Geriatr Cogn Disord

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Cognitive dysfunction is common and clinically important in severe chronic obstructive pulmonary disease (COPD). We investigated the diagnostic accuracy of the Mini Mental State Examination (MMSE) and Instrumental Activities of Daily Living (IADL) scale in screening severe cognitive dysfunction in 149 patients with COPD, mean age 69.3 ± 8.5 years, forced expiratory volume in 1 s = 36.6 ± 17.8% of the predicted. Patients underwent the MMSE and an in-depth neuropsychological assessment based upon the Mental Deterioration Battery (MDB). The 5-item IADL scale was assessed. The sample was randomly divided into a training (n = 73) and a testing (n = 76) population. The diagnostic accuracy of MMSE, IADL scale or both versus cognitive dysfunction corresponding to abnormal performance in 3 or more MDB tests was assessed in the training population and the model obtained was tested in the testing population. The combination of MMSE <24 and dependence in at least 1 IADL had better diagnostic accuracy than either MMSE or IADL, with sensitivity = 52.4, specificity = 82.7, positive predictive value = 55.0% and negative predictive value = 81.1% in the testing population. MMSE and the 5-item IADL scale can be used to exclude, but not to detect cognitive dysfunction in COPD patients. A confirmatory cognitive test should be administered to patients with an MMSE score of <24 and who are dependent in at least 1 IADL.

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Cognitive impairment in chronic obstructive pulmonary disease

Cited by 139 publications

References 33 publications

Low Cognitive Ability in Subjects With Bronchiectasis

Low Cognitive Ability in Subjects With Bronchiectasis

The Evaluation of Cognitive Impairment and Relevant Factors in Patients with Chronic Obstructive Pulmonary Disease

Screening of Cognitive Impairment in Chronic Obstructive Pulmonary Disease

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