Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study

ABSTRACT

Introduction: We evaluated risk factors and demographic characteristics of associated with mild cognitive impairment (MCI) in patients with COPD.

Methods: 220 individuals with COPD enrolled in a cohort study designed to evaluate anxiety conducted at 16 clinical centers. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA), a cutoff score of <26 defined as MCI. Data were collected including spirometry, 6-minute walk test, symptom burden by COPD Assessment Test and dyspnea by Modified Medical Research Council, anxiety measured by Anxiety Inventory of Respiratory Disease, Generalized Anxiety Disorder-7 and Hospital Anxiety Depression Scale, depression by Patient Health Questionnaire-9 and health status by Patient Reported Outcomes Measurement Information System and sleep quality by the Pittsburg Sleep Quality Index.

Results: The median age was 65 years and 54% of participants were male. 119(54%) of participants had MCI as classified by MoCA. In multivariable logistic regression, higher odds ratios (OR) (95% confidence interval) for MCI (MoCA) <26 were associated with increased years of age, 1.06 (1.02 -1-09, p<0.003); African-American race, 3.68(1.67-8.11, p<0.001); persistent phlegm, 2 (1.12-3.57, p<0.01) and sleep disturbance, 1.04(1.01-1.08, p<0.01).

Conclusions: COPD patients commonly screen positive for MCI. Characteristics associated with MCI included age, African-American race, sleep disturbance and persistent phlegm.

KEYWORDS:

• COPD
• mild cognitive impairment
• anxiety
• depression
• sleep disturbance
• race

Article highlights

• Over fifty percent (54%) of COPD patients had mild cognitive impairment (MCI)

• Mild cognitive impairment was related to Black race, older age, persistent phlegm, and sleep disturbance.

• COPD patients should be periodically screened for MCI using a validated scale such as Montreal Cognitive Assessment scale.

• Those at heightened risk of faster cognitive decline should be referred for further assessment of cognitive function.

Acknowledgments

We are most grateful for all research coordinators that helped us in the data collection and COPD patients who participated at 16 centers of the American Lung Association Airways Clinical Research Centers Network (ALA-ACRC) in the US.

Author contributions

Yohannes AM, Eakin MN, Holbrook JT, Sugar EA, Henderson R, Baker AM, Casper AS, Kaminsky DA, Rea AL, Mathews AM, Que LG, Ramsdell JW, Gerald LB, Wise RA, Hanania NA have contributed to study design, data interpretation, final revision of the manuscript. Henderson R has conducted the data analysis and interpretation and final revision of the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

A Yohannes has received a consultation fee from Astra Zeneca. N Hanania has received research grant support (to institution from) from Boehringer Ingelheim, Mylan, Sunovion, Astra Zeneca, GSK, Roche, and Cheisi and honoraria for serving on advisory boards or as a consultant with Astra Zeneca, Roche, Boehringer Ingelheim, Novartis, Mylan, and Sunovion. L Gerald has received research grant support (to institution) from Merck, Sharp, and Dohme Corp.D Kaminsky has received consulting fees from Acorda, TEVA, Spiration, AstraZeneca, honorarium from MGC Diagnostics as well as research grant support to institution from United Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Abbreviations

AIR = Anxiety inventory for respiratory disease

CAT = COPD Assessment Test

COPD = Chronic obstructive pulmonary disease

EQ-5D= EuroQol

GAD-7 = General Anxiety Disorder-7

HADS = Hospital anxiety depression scale

MCI = Mild cognitive impairment

mMRC = modified medical research council scale

MoCA = Montreal cognitive assessment

MMSE = Mini Mental State Examination

PHQ-9 = Patient Health Questionnaire-9

PSQI = Pittsburg Sleep Quality Index

PROMIS = Patient-Reported Outcomes Measurement Information System

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was supported by the American Lung Association (DC002N).