COGNITIVE EFFECTS OF LUNG VOLUME REDUCTION SURGERY

本研究的主要目的是比较肺气肿患者接受肺减容手术（MT+LVRS）与单纯药物治疗（MT）的神经心理功能。该研究将包括国家肺气肿治疗试验（NETT）的两个临床站点的患者。通气和功能容量的增强有望促进脑氧利用率的长期改善，从而导致认知能力的改善，比运动但不接受LVRS的患者更大（Specific Aim 1）。健康控制组将重新进行类似的神经心理学测试，以控制练习效果（具体目标2）。虽然我们不期望情绪（抑郁和焦虑）功能在各组之间有显著差异，但本研究将使我们能够评估随机分组后MT+ LVRS组和MT组情绪状态与神经心理评分之间的关系。此外，由于重大神经事件更有可能在手术后发生，而重大神经事件影响认知功能，我们将评估样本中神经事件的发生率，并确定神经事件与认知功能的关联程度（Specific Aim 3）。目前还没有研究考察LVRS手术后COPD患者认知改变与生活质量改善之间的关系，因此，我们的目的是在Specific aim 4中探讨这些关联。我们建议通过选择神经心理学、心理学、神经学和生活质量测试，在三个时间点（基线、6-10周MT治疗后、MT或LVRS随机化后6个月）检查84例NETT患者（MT 42例，LVRS 42例），比较LVRS和MT后的变化。40名正常对照将在基线进行测试，并进行6-10周的随访。

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.