Cognitive Decline among Patients with Chronic Obstructive Pulmonary Disease
Cognitive Decline among Patients with Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.200902-0276oc
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发表时间：
2009-07-15
影响因子：
24.7
通讯作者：
Ross, Joseph S.
中科院分区：
文献类型：
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作者：
Hung, William W.;Wisnivesky, Juan P.;Ross, Joseph S.
基本原理：先前的研究表明慢性阻塞性肺疾病（COPD）和认知功能下降之间存在关联;然而，这些研究都是横断面或小病例系列研究。目的：确定COPD是否增加了在一个大型的、基于人群的纵向队列中接受调查的老年人认知功能下降的风险。方法：我们纳入了1996年至2002年健康与退休研究浪潮的数据，这是一项两年一度的全国代表性调查。我们研究了在1996年完成认知测试和至少一次后续调查的受访者，并排除了COPD病史未知的受访者。COPD的临床病史基于自我报告;严重程度根据氧气使用或疾病相关活动限制进行分类。我们的主要结果是认知表现，使用经过验证的35分量表进行测量。我们使用多变量混合线性模型分析了COPD对认知的影响，并根据社会人口学和临床特征进行了调整。测量和主要结果：共有4,150名成年人被纳入我们的研究。其中，12%报告了COPD病史（29%为重度，71%为非重度疾病）。在重复测量时，重度和非重度COPD老年人的平均认知评分均显著低于非COPD成年人（分别为2.6分[P < 0.001]和0.9分[P <0.001]）。多变量校正后，重度COPD成人患者的平均评分仍较低（0.9分[P < 0.001]），而非重度COPD成人患者的平均评分与非COPD成人患者相比不再有差异（P = 0.39）。随着时间的推移，重度COPD与标准化测量的较低认知表现相关。
Rationale: Prior research has suggested an association between chronic obstructive pulmonary disease (COPD) and the development of cognitive decline; however, these studies have been cross-sectional or small case series.Objectives: To determine whether COPD increases the risk of cognitive decline among older adults surveyed in a large, population-based longitudinal cohort.Methods: We included data from the 1996 to 2002 waves of the Health and Retirement Study, a biennial nationally representative survey. We studied respondents who completed cognitive testing in 1996 and at least one subsequent survey, and excluded those with unknown history of COPD. Clinical history of COPD was based on self-report; severity was categorized based on use of oxygen or disease-related activity limitations. Our primary outcome was cognitive performance, measured using a validated 35-point scale. We examined the effect of COPD on cognition using multivariable mixed linear models accounting for repeated measurements, adjusted for sociodemographic and clinical characteristics.Measurements and Main Results: A total of 4,150 adults were included in our study. Among them, 12% reported a history of COPD (29% severe, 71% nonsevere disease). On repeated measurement, mean cognition scores of older adults with both severe and nonsevere COPD were significantly lower when compared with adults without COPD (2.6 points [P < 0.001] and 0.9 points [P < 0,001], respectively). After multivariable adjustment, mean scores of adults with severe COPD remained lower (0.9 point [P < 0.001]), whereas mean score of adults with nonsevere COPD was no longer different (P = 0.39) when compared with adults without COPD.Conclusions. Severe COPD was associated with lower cognitive performance on standardized measurement over time.