title: Sequential cognitive skills in emphysema patients following lung volume reduction surgery: a 2-year longitudinal study.
abstract: OBJECTIVE
  This study compared visuomotor speed and cognitive flexibility in emphysema patients treated with either standard multidisciplinary medical therapy (MT) or lung volume reduction surgery (LVRS), followed over a 2-year period.
  
  
  METHODS
  MT patients (n = 544) and 542 LVRS patients completed the Trail Making Test (TMT) Parts A and B prior to randomization (baseline). Testing was repeated at 1 and 2 years.
  
  
  RESULTS
  There were no differences on scores for TMT Parts A and B between the LVRS and MT groups at baseline or at years 1 and 2. No significant difference between MT and LVRS was noted in terms of overall change in TMT Parts A and B over 2 years. The MT group had a significant improvement on TMT Part A at each followup time compared with baseline (P < .03) but the LVRS group did not. Both the MT and LVRS groups had a significant decline in performance (increase in time to completion) on TMT Part B when comparing year 1 with baseline (P < .0001).
  
  
  CONCLUSIONS
  Emphysema patients who received LVRS or MT as treatment performed similarly on measures of visuomotor speed and flexibility at baseline and 1- and 2-year followup. Both groups showed improvement on visuomotor speed during the first year yet overall cognitive flexibility declined. By the second year neither group had any significant change from baseline. These findings suggest that improvement on visuomotor speed and flexibility, observed in a previous 6-month study of LVRS subjects, was not sustained at 1- and 2-year followup.
authors.affiliation: National Jewish Health, Denver, CO 80206, USA. kozorae@njhealth.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kozora
authors.forename: Charles F
authors.initials: CF
authors.lastname: Emery
authors.forename: Lening
authors.initials: L
authors.lastname: Zhang
authors.forename: Karin F
authors.initials: KF
authors.lastname: Hoth
authors.forename: James
authors.initials: J
authors.lastname: Murphy
authors.forename: Barry
authors.initials: B
authors.lastname: Make
mesh_terms: D000368:Aged; D003071:Cognition; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008137:Longitudinal Studies; D008168:Lung / Q000601:surgery; D008297:Male; D011013:Pneumonectomy; D011446:Prospective Studies; D011597:Psychomotor Performance; D011656:Pulmonary Emphysema / Q000601:surgery*; D014145:Trail Making Test / Q000706:statistics & numerical data*; D016896:Treatment Outcome
references.citation: N Engl J Med. 2003 May 22;348(21):2059-73
references.pmid: 12759479
references.citation: Arch Intern Med. 1982 Aug;142(8):1470-6
references.pmid: 7103628
references.citation: Chest. 1999 Dec;116(6):1750-61
references.pmid: 10593802
references.citation: Chest. 1973 Sep;64(3):317-22
references.pmid: 4749376
references.citation: Int J Tuberc Lung Dis. 1999 Dec;3(12):1120-6
references.pmid: 10599017
references.citation: Respir Care. 2008 Sep;53(9):1208-16
references.pmid: 18718041
references.citation: J Consult Clin Psychol. 1983 Feb;51(1):108-16
references.pmid: 6826857
references.citation: Arch Clin Neuropsychol. 2001 Oct;16(7):643-52
references.pmid: 14589783
references.citation: Chest. 2005 Oct;128(4):2653-63
references.pmid: 16236939
references.citation: Health Psychol. 2003 Nov;22(6):598-604
references.pmid: 14640857
references.citation: Respir Med. 2004 Apr;98(4):351-6
references.pmid: 15072176
references.citation: J Cardiopulm Rehabil. 2002 Nov-Dec;22(6):426-30
references.pmid: 12464831
references.citation: Int J Neurosci. 1982 Mar;16(2):99-105
references.pmid: 7166467
references.citation: Arch Intern Med. 1983 Oct;143(10):1941-7
references.pmid: 6625781
references.citation: Am Rev Respir Dis. 1993 Aug;148(2):418-24
references.pmid: 8342906
references.citation: J Gerontol A Biol Sci Med Sci. 2007 Oct;62(10):1134-41
references.pmid: 17921427
references.citation: Chest. 1985 Aug;88(2):239-43
references.pmid: 4017679
references.citation: J Clin Exp Neuropsychol. 1997 Aug;19(4):515-24
references.pmid: 9342687
references.citation: Int Psychogeriatr. 2008 Dec;20(6):1104-15
references.pmid: 18752698
references.citation: Health Psychol. 1998 May;17(3):232-40
references.pmid: 9619472