COPD patients hospitalized with exacerbations have greater cognitive impairment than patients hospitalized with decompensated heart failure

Figures & data

Figure 1 Flowchart of patient recruitment.

Table 1 Clinical and demographic characteristics of participants

	COPD (n=20)	Heart failure (n=20)	P-value
Age (years)	73±10	76±11	0.392
Sex, n (%) (male)	8 (40%)	14 (70%)	0.057
Charlson index	1.3±1.9	1.6±1.5	0.314
APACHE-II score	15.4±3.5	15.9±3.0	0.565
Smoking history (pack years)	51.5±35.0	11.1±15.6	0.001
Alcohol (units/week)	4.5±7.1	9.1±13.1	0.265
Admission to assessment (days)	3.1±3.4	7.9±11.1	0.149
FEV1 (% predicted)	42±19	53±16	0.101
FEV1:FVC (%)	56±14	71±16	0.024
Oxygen saturations (%)	93±4	97±2	0.001
HADS anxiety (maximum 21 points)	9±6	6±4	0.047
HADS depression (maximum 21 points)	10±4	9±4	0.216
C-reactive protein (mg/L)	36.3±49.7	31.3±31.0	0.512
White blood cell count (10^9/L)	13±6	9±3	0.003
Random glucose (mmol/L)	8.2±2.8	8.0±3.0	0.683
Total number of drugs (n)	8.6±3.3	9.9±3.2	0.229
Drugs for COPD (n)a	3.7±0.9	0.6±1.1	<0.001
Drugs for heart failure (n)b	0.6±0.6	2.8±0.6	<0.001
Drugs affecting cognition (n)c	0.8±1.2	0.4±0.8	0.162
CAT (maximum 40 points)	27.8±6.4	21.4±8.4	0.010

Notes: Bold values denote statistical significance.

a Beta-2 agonists, anticholinergics, and corticosteroids.

b Diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, and aldosterone antagonists.

c Opioids, sedatives, antimuscarinics, and antidepressants.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CAT, COPD assessment test; HADS, Hospital Anxiety and Depression Scale.

Table 2 Cognitive assessment

MoCA cognitive domain	COPD (n=20)	Heart failure (n=20)	P-value
Total (maximum 30 points)	20.6±5.6	24.8±3.5	0.007
Visuospatial function (maximum 2 points)	0 (1)	2 (1)	0.003
Executive function (maximum 3 points)	2 (1)	3 (1)	0.035
Naming (maximum 3 points)	3 (1)	3 (1)	0.947
Attention (maximum 6 points)	4 (3)	6 (2)	0.020
Language (maximum 3 points)	2 (2)	3 (1)	0.068
Abstraction (maximum 2 points)	1 (2)	2 (1)	0.165
Delayed recall (maximum 5 points)	3 (4)	3 (2)	0.718
Orientation (maximum 6 points)	6 (0)	6 (0)	0.738

Notes: Gaussian data are presented as mean ± SD and non-Gaussian data are presented as median (IQR). Bold values denote statistical significance where P<0.05.

Abbreviation: MoCA, Montreal cognitive assessment.

Table 3 Correlations with MoCA in COPD

	R value	P-value
APACHE-II score*	0.352	0.152
Smoking history (pack years)*	−0.536	0.022
FEV1 (% predicted)	−0.098	0.740
Oxygen saturations (%)	−0.319	0.197
Random glucose (mmol/L)*	−0.447	0.145
White blood cell count (10^9/L)	−0.180	0.476
CRP (mg/L)*	−0.447	0.081
CAT	−0.277	0.266
HADS total	−0.443	0.065

Notes: Bold values denote statistical significance.

* Non-Gaussian variables were log transformed for parametric analysis. Data presented are corrected for age and sex.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CAT, COPD assessment test; CRP, C-reactive protein; HADS, Hospital Anxiety and Depression Scale; MoCA, Montreal cognitive assessment.

Table 4 Correlations with MoCA in heart failure

	R value	P-value
APACHE-II score*	−0.105	0.679
Smoking history (pack years)*	−0.014	0.974
FEV1 (% predicted)	−0.025	0.948
Oxygen saturations (%)	−0.188	0.456
Random glucose (mmol/L)*	−0.676	0.011
White blood cell count (10^9/L)	−0.348	0.158
CRP (mg/L)*	−0.299	0.229
CAT	−0.189	0.452
HADS total	−0.394	0.105

Notes: Bold values denote statistical significance.

* Non-Gaussian variables were log transformed for parametric analysis. Data presented are corrected for age and sex.

Abbreviations: APACHE, Acute Physiology and Chronic Health Evaluation; CAT, COPD assessment test; CRP, C-reactive protein; HADS, Hospital Anxiety and Depression Scale; MoCA, Montreal cognitive assessment.

Table 5 ANCOVA model of relationships with MoCA

Variables	F (1, 14)	P-value	Partial Eta squared
Group (COPD/HF)	0.235	0.636	0.016
Age	8.406	0.012	0.375
Sex	1.648	0.220	0.105
Random glucose concentration (mmol/L)*	5.079	0.041	0.266
Smoking history (pack years)*	4.585	0.050	0.247
Group by random glucose concentration interaction	1.671	0.217	0.107
Group by smoking history (pack years) interaction	0.884	0.363	0.059

Notes: Bold values denote statistical significance.

* Non-Gaussian variables were log transformed for parametric analysis.

Abbreviations: ANCOVA, analysis of covariance; H F, heart failure; MoCA, Montreal cognitive assessment.