Chest
Original ResearchCOPDCognitive Dysfunction in Patients Hospitalized With Acute Exacerbation of COPD
Section snippets
Study Design
Three groups were recruited prospectively with written consent: (1) patients prior to discharge following hospitalization with acute exacerbation of COPD (n = 30); (2) individuals with stable, nonexacerbating COPD, (n = 50); and (3) locally recruited, healthy control subjects (n = 30). The study was undertaken at St. George's University and St. George's National Healthcare Trust, London, England. Favorable ethical opinion was provided by the Wandsworth and East Central London Research Ethics
Demographic Data
There was no significant difference between the two COPD groups in age, sex, or pack-years smoked. The COPD-E group had worse lung function and SGRQ scores, was relatively more hypoxemic, and had a higher cerebrovascular risk score (Tables 3, 4). Overall, control subjects had a higher education level than both COPD groups and smoked less (Table 5), but the groups did not differ in terms of age or sex. In the COPD-E group, length of stay (LOS) was 7.9 days (range, 1-45 days); four patients
Discussion
This study has shown that patients with COPD who are judged medically fit for discharge following an exacerbation have significant deficits in cognitive function. One-half of the COPD-E group in our study had at least mild impairment of processing speed, and in a significant proportion, the loss was in the pathologic range. These deficits appear to have been acquired at some point in the patient's life, and showed no sign of recovery when assessed 3 months later. The degree of deficit was
Conclusions
Patients awaiting discharge from hospital following an acute exacerbation of COPD have clinically significant, but currently unrecognized, cognitive deficits. It is unclear whether these are acute, chronic, or reversible, but they appear to be related to impaired health. Clinicians should be alert to the impact of these cognitive difficulties in the acute and chronic management of COPD.
Acknowledgments
Author contributions: All authors had full access to the data in the study. Dr Jones takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Dodd: contributed to the study concept and design, participant recruitment, data collection and analysis, and writing the manuscript and also served as principal author.
Dr Charlton: contributed to participant recruitment, data collection and analysis, and writing the manuscript.
Dr van den Broek: contributed to the study
References (30)
- et al.
Construct validity of activities of daily living scale: a clue to distinguish the disabling effects of COPD and congestive heart failure
Chest
(2005) - et al.
“Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician
J Psychiatr Res
(1975) - et al.
Cognitive performance in patients with COPD
Respir Med
(2004) - et al.
Restrictions of the Mini-Mental State Examination in acute stroke
Arch Clin Neuropsychol
(2005) - et al.
Outcomes and markers in the assessment of chronic obstructive pulmonary disease
Eur Respir J
(2006) - et al.
Cognitive function in COPD
Eur Respir J
(2010) - et al.
Brain structure and function in chronic obstructive pulmonary disease: a multimodal cranial magnetic resonance imaging study
Am J Respir Crit Care Med
(2012) - et al.
Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease
Arch Intern Med
(1982) - et al.
Cognitive functioning and survival among patients with chronic obstructive pulmonary disease
Int J Neurosci
(1985) - et al.
Drawing impairment predicts mortality in severe COPD
Chest
(2006)
Chronic obstructive pulmonary disease and associated patterns of memory decline
Dementia
Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation
J Am Geriatr Soc
Cognitive and perceived health status in patient with chronic obstructive pulmonary disease surviving acute on chronic respiratory failure: a controlled study
Intensive Care Med
Coming together: the ATS/ERS consensus on clinical pulmonary function testing
Eur Respir J
A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire
Am Rev Respir Dis
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Funding/Support: This research was supported by an unrestricted research grant from GlaxoSmithKline plc.
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