COPD patients hospitalized with exacerbations have greater cognitive impairment than patients hospitalized with decompensated heart failure
COPD patients hospitalized with exacerbations have greater cognitive impairment than patients hospitalized with decompensated heart failure
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DOI：
10.2147/cia.s185981
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发表时间：
2019-01-01
影响因子：
3.6
通讯作者：
Baker, Emma H.
中科院分区：
文献类型：
--
作者：
Bajaj, Mohani-Preet K.;Burrage, Daniel R.;Baker, Emma H.
目的：慢性阻塞性肺病患者存在认知功能障碍，因病情加重而住院的患者比稳定的门诊患者的认知功能障碍更为严重。我们通过比较因 COPD 急性加重住院的患者和心力衰竭 (HF) 恶化的患者之间的认知，检验了这样的假设：急性加重时的认知功能障碍是 COPD 的疾病特异性特征，而不是因急性疾病住院的非特异性特征。 患者和方法：总共招募了 40 名住院患者，其中 20 名患有 COPD 急性加重的患者和 20 名患有充血性或左侧心力衰竭的患者。排除标准包括既往中风、已知的神经系统疾病和明显的酒精过量。参与者完成了蒙特利尔认知评估 (MoCA) 和医院焦虑和抑郁量表 (HADS)，并进行了肺活量测定和临床记录审查。 结果：年龄（平均值 +/- SD，COPD 73 +/- 10；HF 76 +/- 11 岁）、急性疾病严重程度（急性生理学和慢性健康评估 [APACHE]-II、COPD 15.4 +/- 3.5；HF 15.9 +/- 11 岁） COPD 和 HF 组之间的合并症（查尔森指数，COPD 1.3 +/- 1.9；HF 1.6 +/- 1.5）和教育背景相似。 COPD 患者的 MoCA 总量显着低于 HF 患者（COPD 20.6 +/- 5.6；HF 24.8 +/- 3.5，P=0.007）；然而，在校正年龄、性别和包年吸烟史后，重要性就消失了。与心衰患者相比，COPD 队列在 MoCA 的以下领域表现较差：视觉空间功能（中位数 [IQR]，COPD 0 [1]；HF 2 [1]，P=0.003）、执行功能（COPD 2 [1]；HF 3 [1]，P=0.035）和注意力（COPD 4 [3]；HF 6 [2]， P=0.020）。在全组分析中，年龄（P=0.012）和随机血糖浓度（P=0.041）与认知功能相关，包年吸烟史达到临界显着性（P=0.050）。结论：COPD 和 HF 的 MoCA 总分表明两组都有轻度认知障碍，尽管 COPD 患者的认知障碍更为严重。观察到的慢性阻塞性肺病认知功能障碍的机制尚不清楚，但似乎与血糖浓度和较大的终生吸烟量有关。
Purpose: People with COPD have cognitive dysfunction, which is greater in those hospitalized for exacerbations than in stable outpatients. We tested the hypothesis that cognitive dysfunction at exacerbation is a disease-specific feature of COPD, rather than a nonspecific feature of hospitalization for acute illness, by comparing cognition between patients hospitalized for acute COPD exacerbations and those with worsening heart failure (HF).Patients and methods: A total of 40 hospital inpatients were recruited, 20 patients with COPD exacerbations and 20 patients with congestive or left-sided HF. Exclusion criteria included previous stroke, known neurological disease, and marked alcohol excess. Participants completed the Montreal cognitive assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) and underwent spirometry and review of clinical records.Results: Age (mean +/- SD, COPD 73 +/- 10; HF 76 +/- 11 years), acute illness severity (Acute Physiology and Chronic Health Evaluation [APACHE]-II, COPD 15.4 +/- 3.5; HF 15.9 +/- 3.0), comorbidities (Charlson index, COPD 1.3 +/- 1.9; HF 1.6 +/- 1.5), and educational background were similar between COPD and HF groups. MoCA total was significantly lower in COPD than in HF (COPD 20.6 +/- 5.6; HF 24.8 +/- 3.5, P=0.007); however, significance was lost after correction for age, sex, and pack year smoking history. When compared with HF patients, the COPD cohort performed worse on the following domains of the MoCA: visuospatial function (median [IQR], COPD 0 [1]; HF 2 [1], P=0.003), executive function (COPD 2 [1]; HF 3 [1], P=0.035), and attention (COPD 4 [3]; HF 6 [2], P=0.020). Age (P=0.012) and random glucose concentration (P=0.041) were associated with cognitive function in whole group analysis, with pack year smoking history reaching borderline significance (P=0.050).Conclusion: Total MoCA score for COPD and HF indicated that both groups had mild cognitive impairment, although this was greater in people with COPD. Mechanisms underlying the observed cognitive dysfunction in COPD remain unclear but appear related to blood glucose concentrations and greater lifetime smoking load.