Cognitive decline among patients with chronic obstructive pulmonary disease.
BACKGROUND
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.


OBJECTIVE
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.


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.
Hung
William W
WW
Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1070, New York, NY 10029, USA. william.hung@mssm.edu
Wisnivesky
Juan P
JP
Siu
Albert L
AL
Ross
Joseph S
JS
D000368:Aged; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000453:epidemiology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D012123:Pulmonary Ventilation; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology