COPD associated with increased risk for nonamnestic-mild cognitive impairment

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1. In a population based study of older adults, COPD was associated with an almost two-fold increased risk for nonamnestic-mild cognitive impairment (NA-MCI). 

2. The relationship between COPD and MCI appeared to be dose-dependent, wherein a longer duration of COPD was associated with a greater risk for MCI. 

Evidence Rating Level: 2 (Good)

Study Rundown: COPD causes a state of hypoxemia and hypercapnia. Previous studies have suggested that this may result in mild cognitive impairment (MCI), which can progress to dementia. This study was conducted to further characterize the relationship between COPD and MCI. Participants were chosen from Mayo Clinic Study of Aging (MCSA). The results suggested that COPD was associated with an almost two-fold increased risk for NA-MCI. There appeared to be a dose-response relationship that suggested that duration of COPD longer than five years had a greater risk for NA-MCI.

The strength of this study was the population based cohort of participants and the thorough battery of tests used to determine the cognitive status of the participants. They also accounted for a large number of co-morbidities and other confounding variables in the statistical analysis to isolate COPD as an independent risk factor for MCI. However, there were several weaknesses as well. The study population was mostly Caucasian and of Northern European ancestry, limiting its generalizability. In addition, the diagnosis of COPD was based on medical providers’ comments or medication prescriptions rather than from spirometry results. The hazard ratio confidence intervals were wide, suggesting the study may have been somewhat underpowered.

Click to read the study, published today in JAMA Neurology

Relevant Reading: Chronic obstructive pulmonary disease and asthma and the risk of mild cognitive impairment and dementia: a population based CAIDE study

In-Depth [prospective cohort study]: This study consisted of 1,425 cognitively normal adults in the age range 70-89yrs. They were chosen from the Mayo Clinic Study of Aging (MCSA) cohort from Olmsted County, Minnesota with a mean follow up period of 5.1yrs. The cognitive status of the participants was determined by a composite score of Clinical Dementia Rating Scale, Short Test of Mental Status, Unified Parkinson’s Disease Rating Scale, and a neuropsychological battery test, along with consensus agreement between testers. Diagnosis and duration of COPD was determined from medical records.

Out of total participants, 370 developed MCI, of which 97 (26.2%) had NA-MCI. At baseline, 171 participants had a diagnosis of COPD. After using the statistical model that accounted for the most number of confounding variables, COPD was associated with an increased risk for NA-MCI (HR 1.83; 95% CI, 1.04-3.23). There was no statistically significant association between COPD and other subtypes of MCI. Furthermore, there was a dose-response relationship between the duration of COPD and NA-MCI, in which there was a greater risk for NA-MCI if the duration of COPD was longer than 5yrs (HR 2.58; 95% CI, 1.32-5.06) compared to duration fewer than 5yrs (HR 1.14; 95% CI, 0.46-2.79).

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