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Cognitive Decline among Patients with Chronic Obstructive Pulmonary Disease

¹ Department of Geriatrics and Adult Development, and ³ Department of Medicine, Divisions of General Internal Medicine and of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, New York; and ² Health Services Research and Development Service Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York

Correspondence and requests for reprints should be addressed to William W. Hung, M.D., M.P.H., Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1070, New York, NY 10029. E-mail: william.hung{at}mssm.edu

Rationale: Prior research has suggested an association between chronic obstructive pulmonary disease (COPD) and the development of cognitive decline; however, these studies have been cross-sectional or small case series.

Objectives: To determine whether COPD increases the risk of cognitive decline among older adults surveyed in a large, population-based longitudinal cohort.

Methods: We included data from the 1996 to 2002 waves of the Health and Retirement Study, a biennial nationally representative survey. We studied respondents who completed cognitive testing in 1996 and at least one subsequent survey, and excluded those with unknown history of COPD. Clinical history of COPD was based on self-report; severity was categorized based on use of oxygen or disease-related activity limitations. Our primary outcome was cognitive performance, measured using a validated 35-point scale. We examined the effect of COPD on cognition using multivariable mixed linear models accounting for repeated measurements, adjusted for sociodemographic and clinical characteristics.

Measurements and Main Results: A total of 4,150 adults were included in our study. Among them, 12% reported a history of COPD (29% severe, 71% nonsevere disease). On repeated measurement, mean cognition scores of older adults with both severe and nonsevere COPD were significantly lower when compared with adults without COPD (2.6 points [P < 0.001] and 0.9 points [P < 0.001], respectively). After multivariable adjustment, mean scores of adults with severe COPD remained lower (0.9 point [P < 0.001]), whereas mean score of adults with nonsevere COPD was no longer different (P = 0.39) when compared with adults without COPD.

Conclusions: Severe COPD was associated with lower cognitive performance on standardized measurement over time.

Key Words: chronic obstructive pulmonary disease • cognitive impairment • longitudinal survey

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Although prior cross-sectional and clinical studies have suggested a relationship between chronic obstructive pulmonary disease and cognitive decline, longitudinal evidence of this relationship is lacking. What This Study Adds to the Field In this study, we showed that severe chronic obstructive lung disease is associated with poorer cognitive performance on standardized measurements over time.