Drawing impairment predicts mortality in severe COPD.
BACKGROUND
Cognitive impairment frequently occurs in elderly COPD patients, but little is known about its prognostic implications. We aimed at evaluating the prognostic role of cognitive impairment in patients with severe COPD.


METHODS
Our series consisted of 149 stable patients (mean [+/- SD] age, 68.7 +/- 8.5 years) with COPD and a Pao(2) of < 57 mm Hg at rest (n = 97) or at the end of the 6-min walking test (n = 37) who were enrolled in a prospective observational study. After a multidimensional baseline assessment, patients were followed up by telephone calls for a mean duration of 32.5 +/- 9.2 months (minimal follow-up duration, 24 months); 134 patients were successfully tracked. We used multivariable Cox proportional hazard analysis to identify predictors of death among clinical/functional variables that previously were shown to have prognostic implications and among neuropsychological indexes selected on the basis of univariate analysis.


RESULTS
We observed 29 deaths over a median follow-up time of 32 months. Only the two following variables were independently associated with the outcome: an abnormal score on the copy with landmark test (hazard ratio [HR], 2.93; 95% confidence interval [CI], 1.34 to 6.39); and a 6-min walk distance of < 300 m (HR, 3.46; 95% CI, 1.15 to 10.5). A Pao(2) of < 57 mm Hg at rest (HR, 2.19; 95% CI, 0.93 to 5.18) and an FEV(1) of < 40% predicted (HR, 2.74; 95% CI, 0.99 to 7.57) were nearly significantly associated with the outcome, while Paco(2), body mass index, physical dependence, comorbid diseases, and the impairment of cognitive domains other than drawing impairment were unrelated to the outcome.


CONCLUSIONS
Drawing impairment is a risk factor for mortality and might improve the assessment of hypoxemic COPD patients.
Antonelli-Incalzi
Raffaele
R
Geriatric Medicine, University Campus Bio-Medico, Rome, Italy.
Corsonello
Andrea
A
Pedone
Claudio
C
Trojano
Luigi
L
Acanfora
Domenico
D
Spada
Aldo
A
Izzo
Orsola
O
Rengo
Franco
F
D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007558:Italy; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011594:Psychometrics / Q000706:statistics & numerical data; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality* / Q000523:psychology* / Q000534:rehabilitation; D016019:Survival Analysis
D010100:Oxygen