An integrated epidemiological approach to understanding the relationship between lung health and multi-morbidity

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The UK spends 70% of its healthcare budget caring for patients with multiple long-term health conditions such as dementia and chronic obstructive pulmonary disease (COPD); driven by aging populations and lifestyle factors, this figure is expected to rise. Chronic lung disease and dementia are therefore key global health challenges. Cognition describes mental abilities, such as thinking, problem solving and remembering. Problems with cognition (cognitive dysfunction) can lead to dementia and appear very common in people with chronic lung disease. Although cognitive dysfunction may be mild and unnoticed at first, it may gradually make it more difficult for patients to perform their daily activities including taking medicines correctly. Cognitive dysfunction in chronic lung disease eventually leads to worse health, more time in hospital and shorter survival.Individuals with chronic lung disease may be at increased risk of mild cognitive impairment (MCI) and dementia due to a combination of factors, which are both more frequent among those with lung disease and known to negatively impact on cognition (e.g., smoking and high blood pressure) or as a direct result of lung disease (e.g., low oxygen levels). However, there does seem to be a consistent link between cognitive impairment and lung disease independent of these shared factors, suggesting mechanisms specific to respiratory limitation. The aim of this project is to determine whether chronic lung disease and cognitive impairment share a common causal pathway. It will do this by bringing together interdisciplinary expertise in epidemiology and statistics, to understand the complex interaction between genetic, developmental and early life events which determine lung health and cognition (MRC strategic aim 4). It will also explore the relationship between early life cognition, co-morbidity and lung function trajectories using a population-based life course perspective applied to the Avon Longitudinal Study of Parents And Children (ALSPAC) cohort. (MRC strategic aim 1). The objectives are:a) Apply integrated genetic epidemiological methods developed by our team (2 sample Mendelian Randomisation) from large European populations to determine the causal association between lung function, cognitive impairment and risk of dementiab) Determine if early life changes in lung function are associated with cognitive dysfunction and multi-morbidity using existing data from the ALSPAC cohort.Benefits and applications are:1) Help to identify modifiable risk factors and potential therapeutic targets to reduce the risk of developing dementia. 2) Advance our understanding behind the mechanisms of cognitive dysfunction in chronic lung disease. 3) Initiate the development of new ways to detect, prevent or delay progression of cognitive dysfunction in at risk populations. This will help patients to manage their treatment, maintain their health and keep out of hospital. It could also prolong survival.4) Increase our understanding about early life risk factors for chronic lung disease and multi-morbidity5) Inform public health policy through engagement with organisations responsible for health services delivery and management of two major long-term conditions, Chronic Obstructive Pulmonary Disease (COPD) and Dementia.a. Awareness of cognitive dysfunction & multi-morbidityb. Inform self-management and educationc. Keeping people with COPD and Dementia healthy at home6) Inform and open new research questions about the interaction between long-term conditions and lung health such as cardiovascular disease, depression and diabetes.