COGNITIVE EFFECTS OF LUNG VOLUME REDUCTION SURGERY

本研究的主要目的是比较接受肺减容手术(MT+LVRS)和单纯药物治疗(MT)的肺气肿患者的神经心理功能。这项研究将包括全国肺气肿治疗试验(NETT)两个临床地点的患者。预计通风和功能能力的增强将有助于更长期地改善大脑中氧气的利用，从而导致认知能力的改善，其改善幅度大于那些锻炼但没有接受左肺减容的患者(具体目标1)。健康对照组将接受类似的神经心理测试，以控制练习效果(具体目标2)。虽然我们预计不同组之间的情绪(抑郁和焦虑)功能不会有显著差异，但这项研究将使我们能够评估随机化后MT+LVRS组和MT组的情绪状态与神经心理评分之间的关系。此外，由于手术后更有可能发生重大神经事件，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(具体目标3)。目前尚无研究探讨慢性阻塞性肺疾病患者LVRS术后认知改变与生活质量改善之间的关系，因此，我们的目标是有针对性地探讨这些关系。我们建议通过对84例NETT患者(MT组42例，LVRS组42例)在三个时间点(基线、内科治疗6-10周后、MT或LVRS随机化后6个月)进行神经心理学、心理学、神经学和QOL测试，比较两种手术后认知改变和生活质量的变化。40名正常对照将在基线和6-10周的随访中进行测试。

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.