COGNITIVE EFFECTS OF LUNG VOLUME REDUCTION SURGERY

本研究的主要目的是检查肺气肿患者接受肺减容手术（MT+LVRS）与单纯药物治疗（MT）相比的神经心理功能。该研究将包括两个临床试验点的国家肺气肿治疗试验（NETT）患者。预计通气和功能能力的增强有助于更大程度地长期改善大脑中的氧气利用，从而导致认知能力的改善大于在运动但未接受LVRS的患者中观察到的改善（具体目标1）。将对健康对照组进行类似的神经心理学测试，以控制练习效果（具体目标2）。虽然我们不期望各组之间的情绪（抑郁和焦虑）功能存在显著差异，但本研究将使我们能够评估随机分组后MT+ LVRS组和MT组的情绪状态与神经心理学评分之间的关系。此外，由于手术后更可能发生重大神经系统事件，并且重大神经系统事件影响认知功能，因此我们将评价样本中神经系统事件的发生率，并确定神经系统事件与认知功能的相关程度（具体目标3）。尚无研究探讨COPD患者LVRS手术后认知变化与生活质量改善之间的关系，因此，我们的目的是在具体目标4中探索这些相关性。我们建议使用选择的神经心理学、心理学、神经学和生活质量测试，在三个时间点（基线、6-10周药物治疗MT后和MT或LVRS随机化后6个月）检查84例NETT患者（MT组42例，LVRS组42例），比较LVRS和MT后的变化。40名正常对照将在基线和6-10周随访时进行测试。

The primary goal of this study is to examine the neuropsychological functioning of emphysema patients undergoing lung volume reduction surgery (MT+LVRS) compared to medical therapy alone (MT). The study will include patients at two clinical sites for the National Emphysema Treatment Trial (NETT). Enhancements of ventilation and functional capacity are expected to contribute to greater long-term improvements in utilization of oxygen in the brain, thereby leading to improvements in cognitive performance greater than those observed among patients who exercise but do not receive LVRS (Specific Aim 1). A health control group will be retested on similar neuropsychological tests in order to control for practice effects (Specific Aim 2). Although we do not expect significant differences in emotional (depression and anxiety) functioning across groups, this study will enable us to evaluate the relationship between emotional status and neuropsychological scores in the MT+ LVRS and MT groups following randomization. In addition, since major neurological events are more likely following surgery, and major neurological events affect cognitive function, we will evaluate the incidence of neurological events in our sample and will determine the degree to which neurological events are associated with cognitive function (Specific Aim 3). No studies have examined the relationship between change in cognition and improve quality of life in COPD patients following LVRS surgery, therefore, we aim to explore these associations in Specific Aim 4. We propose to compare changes following LVRS and MT by examining 84 NETT patients (42 in MT, 42 in LVRS) at three times points (baseline, post 6-10 week medical treatment MT, and 6 months post MT or LVRS randomization) using select neuropsychological, psychological, neurological and QoL tests. Forty normal controls will be tested at baseline and 6-10 weeks follow- up.