Patients Hospitalized With COPD Have Worse Cognition Scores

Patients hospitalized with exacerbations of chronic obstructive pulmonary disease (COPD) had worse impairments of cognition compared to those hospitalized without the disease, according to a recent study.

The research was undertaken to test the idea that cognitive dysfunction at exacerbation is a disease-specific feature of COPD, rather than a nonspecific feature of hospitalization for acute illness, by comparing cognition between patients hospitalized for acute COPD exacerbations and those with worsening heart failure (HF).

Previous research has shown that cognitive impairment was reported to affect 1 in 3 patients with COPD. Impaired cognition in people with COPD is associated with reduced treatment adherence, impaired performance in daily activities, and increased mortality.

The researchers said that understanding what causes cognitive impairment in people with COPD is important in order to identify factors that could be modified to improve health outcomes.

In the study, 40 hospital inpatients were recruited and divided into 20 patients with COPD exacerbations and 20 patients with congestive or left-sided HF. Exclusion criteria included previous stroke, known neurological disease, and marked alcohol excess. Participants completed the Montreal cognitive assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) and underwent spirometry and review of clinical records.

The mean age for patients with COPD was 73, and the mean for patients with HF was 76. Acute illness severity, comorbidities, and educational background were similar between the 2 groups.

MoCA total was significantly lower in COPD than in HF (COPD 20.6±5.6; HF 24.8±3.5, P = .007); however, significance was lost after correction for age, sex, and pack year smoking history. When compared with HF patients, the COPD cohort performed worse on the following domains of the MoCA: visuospatial function (median interquartile range, COPD 0 [1]; HF 2 [1], P = .003), executive function (COPD 2 [1]; HF 3 [1], P= 0.035), and attention (COPD 4 [3]; HF 6 [2], P = .020).

Age (P = .012) and random glucose concentration (P = .041) were associated with cognitive function in whole group analysis, with pack year smoking history reaching borderline significance (P = .050).

Total MoCA score for COPD and HF indicated that both groups had mild cognitive impairment, although this was greater in people with COPD.

Cognitive impairment was associated with pack-year smoking history, rather than systemic inflammation or hypoxia, indicating that smoking could be an underlying cause.

In addition, in hospitalized patients with either COPD or HF, random blood glucose was associated with cognitive impairment, indicating a potential contributing role for diabetes. Awareness of the prevalence of cognitive impairment in hospitalized patients with COPD has importance for treatment adherence and discharge planning to reduce readmissions, the researchers said.

Reference

Baja MPK, Burrage DR, Tappouni A, Dodd JW, Jones PW, Baker EH. COPD patients hospitalized with exacerbations have greater cognitive impairment than patients hospitalized with decompensated heart failure. [published online December 18, 2018]. Clin Interv Aging. doi: 10.2147/CIA.s185981.