COPD with Cognitive Status in an Elderly Sample

COPD with cognitive Status in an Elderly SampleCOPD with Cognitive Status in an Elderly Sample employ the Third guinea pig wellness and maintenance Examination slewDean Sherzai, MD MAS PhD(c), Rachel Schade, Sonia Vega, Ayesha Z. Sherzai, MDAuthors Affiliations 1Department of Neurology and Neurological Sciences, Cedar Sinai Health System, Los Angeles, CA, the States 2Keck Science Department, Pitzer College, Cl bemont, CA, USA 3Department of Epidemiology and Biostatistics, Loma Linda School of Public Health, Loma Linda, USA Department of Neurology, The Neurological Institute of unused York, Columbia University Medical Center, New York, New York, USA.Key interchanges COPD, cognitive term, dementia, aging purloinPurpose Chronic preventive Pulmonary ailment (COPD) has been associated with dementia and cognitive impairment. We attempted to assess the alliance among COPD and cognitive impairment in a nationwide allotive informationbase, the guinea pig Health and Nutrition Exami nation Survey (NHANES collar).Methods Data was analyzed from the NHANES common chord database, a nationally illustration thwartwise sectional observational study among older adults. The diagnosis of COPD was based on calculation of FEV1/FVC ratio, with a cutoff of 0.7. The betting betting betting odds of having poor cognitive experimental condition was assessed using logistic regression models between COPD and troika cognitive examinations (immediate give back, delay recall, and inci retreattal subtraction tests), set for demographic variables and medical comorbidities.reticuloendothelial systemults We identified 17,181,182 individuals with a diagnosis of COPD. The mean fester of was 71.5 0.19 years. In the crude model, there was a dependable affinity between those with COPD and poor cognitive test markers. This alliance was streng soed in the multivariate model modify for demographic variables and vascular comorbidities, such that those with COPD had a graduate(p renominal) odds of having afflicted immediate recall (OR 2.56, 95% CI 1.44- 4.53), slow recall (OR 3.10, 95% CI 1.73- 5.52), and incidental subtraction tests scores (OR 2.74, 95% CI 1.17- 6.40).Conclusions Individuals with COPD be possessed of a higher odds of having cognitive impairment in this large nationally representative database.IntroductionApproximately 35.6 million currently suffer from dementia worldwide, and this issuing is expected to double by 2030 and triple by 2050 1. In the stand few years we cause become more(prenominal) cognizant of the enormousness of identifying cognitive even out at the earlier stages when it is more amenable to treatment. We pee-pee also become more knowledgeable about doable comorbidities that whitethorn propagate the process of cognitive decline and ultimate dementia.Causes of cognitive decline, and possible progression to dementia, are believed to be multi component partial. Chronic Obstructive Pulmonary Disease (COPD) is a progre ssive malady that affects more than 13.5 million people in the United States and has been associated with cognitive decline 2. To date, there are no authorised treatments for dementia therefore, much emphasis had been placed on the prevention of dementia, and credit of modifiable peril factors early in the illness process. Multiple studies have reported the association between COPD and either spherical cognitive deficits with the near gross(a) deficiencies in specific cognitive domains such as perception, ride function or memory 3. Despite the current bole of evidence, the bulk of studies are based on a single region, and there are a few studies that used a nationally representative data (Health and Retirement Study). Given that society is facing an increase in the stride of inveterate diseases of aging 4, and the lack of large scale investigation on the relationship between COPD and diminished cognitive posture, we analyzed this nationwide database, the National Health and Nutrition Examination Survey (NHANES III), to better elucidate this relationship.Materials and MethodsNHANES III is a cross sectional wellness survey conducted by the National Center for Health Statistics (NCHS), performed from 1988 to 1994 in persons aged two months and older in the United States. NHANES has a multistage, probability sampling design used to select participants representative of the civilian, non-institutionalized US universe of discourse. Our study population consisted of 39,488,973 adults 60 to 89 years. Of these, participants were include if they had measurements for spirometry and the cognitive tests. Based on The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) standards, cases of COPD were defined based on the patients ratio of forced expiratory volume (FEV1) to the forced vital expertness (FVC). Patients with a ratio of less than 0.7 were classified with COPD. Our control group, patients without COPD, was classified by a ratio greater than 0.7. For the older population, NHANES-III measures cognitive status with trio cognitive tests an immediate and delayed logical verbal memory test from the East Boston Memory Test, a three word enrollment/memory task (apple, table and penny) and five serial subtractions by intervals of three. A point was awarded for every correct answer from the three word memory task and the logical verbal memory test. For immediate memory, using a summary score of logical memory (0-6 points) plus three word task (0-3 points), we considered less than 5 out of 9 points to be impaired (low), such that individuals with 0-4 were score low, and those scoring 5-9 were scored high. For delayed memory, a summary score of less than 4 out of 9 points was considered impaired (low). Both summary scores are consistent with previous NHANES-III reports. For the test of serial subtractions, any miscalculation during the five trials was considered impaired, and only a perfect score was considered high.The rep orted race and ethnicity includes non-Hispanic Whites, non-Hispanic Blacks, Mexican-Americans and other. have was defined by a yes response to the following two questions rich person you smoked at least 100 cigarettes during your entire life and Do you smoke cigarettes now. These questions can be anchor on the NHANES III household adult questionnaire. fostering was stratified in three categories 12 (some college and beyond).We performed an X2 and t-test analysis to compare demographic characteristics between patients with COPD and patients without COPD. To assess the association between COPD and a low cognitive test score (with high score as reference) crude and adjusted logistic regression analysis were performed. adjust potential confounders were age, race-ethnicity, sex, BMI, education status and smoking. Appropriate NHANES-III weighted sampling was employ during this analysis. All data analyses were conducted using SAS (v 9.3 SAS Institute Inc., Cary, NC).Results put over 1 presents the demographics of the population. there were 17,181,182 individuals with COPD 50.1% were females, 49.9% males and 85.9% were non-Hispanic White. The mean age for patients with COPD was 71.50.19. In both groups, patients had less than a high school education, were non-smokers and had both hospital and medical insurance coverage. Majority of individuals with COPD scored low on each cognitive test as compared to those without COPD (Table 1). Coronary artery disease was the most prevalent comorbidity in patients with COPD (31.9%) and in patients without COPD (30.4%).In the unadjusted model, participants with COPD had change magnitude odds of impaired scores on each of the three cognitive tests the immediate recall (OR 2.18, 95% CI 1.81- 2.62), delayed recall (OR 2.25, 95% CI 1.87- 2.70) and serial subtraction test (OR 1.44, 95% CI 1.10-1.90).We then examined the association between COPD and the cognitive tests, initially adjusted by age and race, which diminished the re lationship slightly for all three tests, but the relationship was rendered in world-shaking for the serial subtraction test (OR 1.29, 95% CI 0.95-1.69) (Table 2). Then, we adjusted for age, sex, height, body mass index and education, which did non change the relationship significantly. In the third model, further adjustment for race, poverty income ratio, and medical coverage did non appreciably change the relationship. In the last model, we additionally adjusted for vascular risk factors such as smoking, stroke, hypertension, CHF, diabetes and coronary artery disease. This increased the odds for poor scores for all three tests immediate recall (OR 2.56, 95% CI 1.44- 4.53), delayed recall test (OR 3.10, 95% CI 1.73- 5.52), and serial subtraction (OR 2.74, 95% CI 1.17- 6.40).DiscussionWe were able to identify a strong association between COPD and diminished cognitive status crosswise three common cognitive tests. Individuals with COPD had significantly greater odds of impaired verb al memory, and this relationship remained robust after adjusting for potential sociodemographic and vascular risk factors. The relationship between COPD and the serial subtraction test scores was rendered significant after it was adjusted for vascular risk factors. Despite evidence in the extant literature showing an association between race with cognitive status 10, race was not a factor in the relationship between COPD and cognitive status.Our results are consistent with a growing body of evidence that has revealed a strong association between COPD and poor cognitive function. In one of the largest epidemiological studies, The Health and Retirement Study (n=4,150), patients with severe and non-severe COPD had significantly humble cognitive test scores compared to healthy controls. In adjusted models, only patients with severe COPD had the lower scores on the cognitive tests 5. Furthermore, a dose-response relationship between COPD severity and cognitive dysfunction was antecedent ly established, with more severe COPD cases performing worse on the cognitive tests 6. Notably, a 2013 study contendd significantly reduced memory tests scores on the Mini Mental State Exam (MMSE) among patients with COPD but without hypoxemia 7. Further evidentiary support for global cognitive impairment in patients with COPD was also shown in a study that observed significant differences in executive performance, working memory, episodic memory, processing speed, and visuospatial ability 8. Recently, several COPD studies have combined cognitive testing with neuroimaging, which have revealed significant white matter pathology in this population, with variable degrees of cognitive impairment 8,9,10,11.The mechanism by which COPD causes cognitive decline is not very clear. COPD results in hypoxemia and hypercapnia, which has been implicated in diminished cognitive status 3,5. Recent imaging studies have pointed to possible microvascular damage 3, and other studies have implicate d chronic inflammatory process causing cognitive decline 12. Yet others believe that the hypoxic process may cause direct nervous damage, glial activation and the generation of free radicals which could affect cognitive functioning 13. Given the prevalence of both COPD and cognitive decline in the time-worn population and a probable causal relationship, it is distinguished to further look into the mechanism underlying the relationship.LimitationsAs all studies, this one has many limits that get to be visited. One of the limitations unique to our study was that majority of the individuals in our senile NHANES population had less than high school education. Given that educations has repeatedly been found to be strongly correlated with resilient cognitive function as well as less susceptible to neurodegeneration, our results could have been confounded by the lower mean education level in our population14-18. Another limitation lies with the cognitive testing used by NHANES. Onl y three cognitive tests were utilized, which does not provide a comprehensive assessment of cognitive function. In addition, the cognitive tests used most likely overlap in the cognitive function they measure, not allowing for specificity. However, the cognitive variables have been validated as a good tool for testing memory 19. Furthermore, the cross-sectional nature of this written report does not allow us to make a causal link. In addition, the restricted scope of lifelong socioeconomic status is a limitation, which is strongly associated with both cognitive impairment and COPD. However, it has been demonstrated that individuals with poor socioeconomic status may have a higher risk of developing COPD and lower cognitive reserve 20,21. The strengths of this study are its large, diverse representative sample, that provided drawn-out medical history and allowed for control of confounding variables, as well as the objective measure of cognitive impairment and COPD. Also, the spirom etry data from NHANES III allowed for more accurate diagnosis of COPD.ConclusionWe were able to demonstrate a strong relationship between COPD and diminished cognitive status. We were not able to demonstrate any effect of gender, race, as well as sociodemographic or vascular risk factors on this relationship between COPD and cognitive status. The independent relationship between COPD and cognitive status may provide us an important clue into the pathophysiology of dementia, which needs to be further explored.Declaration of InterestReferencesPrince M, Bryce R, Albanese E, et al. The global prevalence of dementia a systematic review and meta-analysis. Alzheimers Dementia 20139(1)63-75. crossbreeding ES, Croft JB, Mannino DM, et al. COPD Surveillance- United States, 1999-2011 COPD Surveillance. Chest 2013144(1)284-305.Dodd JW, Getov SV, Jones PW. Cognitive function in COPD. Eur Resp J 201035(4)913-922.Dall TM, Gallo PD, Chakrabarti R, et al. 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