Changes in Cognitive Status in COPD Patients Across Clinical Stages

Figures & data

Table 1.  Details on the subtests of the MoCA.

Cognitive area	Explanation	Score range
Visuoconstructional skills and executive functions	Visuospatial abilities are assessed using a clock-drawing task (3 points) and a three-dimensional cube copy (1 point). Executive functions are assessed using an alternation task adapted from the Trail Making B task (1 point).	0 to 5
Naming	In this area the subject has to identify three different animals.	0 to 3
Memory	In this area the examiner reads a list of 5 words at a rate of one per second and the subject has to repeat the list of words.	This section does not receive points.
Attention	This area includes tests to forward digit span (1 point), backward digit span (1 point), vigilance (1 point) and serial 7 subtracting (3 points).	0 to 6
Language	This area includes tests to sentence repetition (2 points) and verbal fluency (1 point).	0 to 3
Abstraction	This area includes tests to similarities between objects.	0 to 2
Delayed recall	In this area the subject has to repeat the list of 5 words memorized previously.	0 to 5
Orientation	In this area patients are ask some questions about orientation to time and place.	0 to 6

Figure 1.  Distribution of patients across the study.

Table 2.  Patients' characteristics across clinical stages.

	Exacerbation (n = 48)	At discharge (n = 48)	Stable (n = 48)	F
Sex (% men)	75.8	75.8	75.8	-
Age (years)	70.12 ± 8.63	70.12 ± 8.63	70.12 ± 8.63	-
BMI (kg/m^2)	27.28 ± 7.69	28.56 ± 8.12	29.72 ± 6.84	10.620
Barthel index	93.27 ± 9.48	94.05 ± 10.65	93.24 ± 11.54	3.852
MNA	22.56 ± 5.37	24.09 ± 4.93	19.24 ± 10.11	40.357^b^b)
HAD	7.10 ± 5.64	5.28 ± 6.85	5.50 ± 5.75	73.123^c^c)
St. George Respiratory Questionnaire
Symptoms subscore	47.12 ± 11.45	51.21 ± 10.63	48.75 ± 10.72	5.128
Activity subscore	75.32 ± 9.15	76.41 ± 12.07	77.65 ± 18.45	4.671
Impact subscore	45.60 ± 8.56	46.75 ± 8.13	42.12 ± 8.73	5.068
Total Score	54.91 ± 9.54	56.57 ± 9.41	55.60 ± 5.14	7.958

Continuous variables were expressed as mean ± SD, categorical variables were expressed as a percentage. *p < 0.05. BMI: Body Mass Index, MNA: Mini Nutritional Assessment, HAD: Hospital Anxiety and Depression Scale.

a) a) significant differences between Exacerbation to discharge

b) b) significant differences between discharge to Stable

c) c) significant differences between Exacerbation to Stable.

Table 3.  Patients' clinical profile across clinical stages.

	Exacerbation (n = 48)	At discharge (n = 48)	Stable (n = 48)	F
SO2	89.58 ± 6.74	90.89 ± 3.26	91.63 ± 3.68	3.789^a,c^a), c)
Predicted FVC %	63.69 ± 10.26	65.82 ± 15.31	63.70 ± 14.17	6.256
Predicted FEV1%	46.25 ± 15.41	49.65 ± 12.02	50.73 ± 15.23	3.405^a^a)
Dyspnea	6.58 ± 2.68	2.25 ± 1.4	4.10 ± 2.07	50.159^a,b,c^a), b), c)

Continuous variables were expressed as mean ± SD. *p < 0.05. SO₂: Saturation Oxygen, FVC: Forced Vital Capacity, FEV₁: Forced Expiratory Volume in 1 second.

a) a) significant differences between exacerbation to discharge

b) b) significant differences between discharge to stable

c) c) significant differences between exacerbation to stable.

Table 4.  Cognitive variables values across clinical stages.

	Exacerbation (n = 48)	At discharge (n = 48)	Stable (n = 48)	F
Visuoconstructional subscore	2.98 ± 1.33	3.78 ± 1.24	3.26 ± 1.02	49.164^a,b^a), b)
Naming subscore	2.56 ± 0.63	2.84 ± 0.85	2.63 ± 0.58	42.357^b,c^b), c)
Attention subscore	4.86 ± 0.81	5.13 ± 1.06	4.63 ± 1.34	52.658^a,c^a), c)
Language subscore	1.04 ± 1.84	1.33 ± 0.82	1.12 ± 0.65	59.623^a,c^a), c)
Abstraction subscore	0.94 ± 0.56	1.23 ± 0.68	1.43 ± 0.57	70.351^a,c^a), c)
Delayed recall subscore	1.46 ± 0.85	1.89 ± 0.57	1.74 ± 1.08	56.958^a,c^a), c)
Orientation subscore	5.09 ± 1.46	5.84 ± 0.96	5.37 ± 0.64	43.578^a^a)
MoCA total score	19.28 ± 2.08	23.91 ± 3.74	21.28 ± 2.31	55.260^a,b,c^a), b), c)

Continuous variables were expressed as mean ± SD. * p< 0.05. MoCA: Montreal Cognitive Assessment. MoCA subscales: visuoconstructional, naming, attention, language, abstraction, delayed recall and orientation

a) a) significant differences between exacerbation to discharge

b) b) significant differences between discharge to stable

c) c) significant differences between exacerbation to stable.