The Evaluation Of Cognitive Impairment And Associated Factors In Senior Patients With Chronic Obstructive Pulmonary Disease

Objective To evaluate cognitive function in different stages and grades of chronic obstructive pulmonary disease?COPD?among senior patients,and to analyze the influencing factors of cognitive dysfunction.Methods From Jun.to Dec.2016,126 patients with COPD were enrolled in the Department of Geriatrics Respiratory Medicine in Shaanxi Provincial People's Hospital.According to the different stages and grades of the disease,There are 32 patients in group A1,which is in mild or moderate seniors?FEV1%pred?50%?with acute exacerbation of COPD?AECOPD?,26 patients in group A2,which is in severe or very severe stage AECOPD?FEV1%pred<50%?,34 patients in group S1,which is in mild or moderate stage stable COPD?FEV1%pred?50%?,and 34 patients in group S2,which is in severe or very severe stage stable COPD?FEV1%pred<50%?.Demographic and social information such as gender,age,educational background,history of smoking,cohabitation and the class of medical insurance were collected from every patient.Medical history data like heart disease and hypertension were investigated as well.The exacerbations of COPD in recent a year and the duration of COPD were gathered from patients.Lung function tests?FEV1 and FVC?,arterial blood-gas analysis?p H?Pa O₂ and Pa CO₂?,serum electrolytes analysis?natrium,potassium,chloride?and fractional exhaled nitric oxide?Fe NO?.Cognitive function and detailed cognitive domains were assessed by MMSE and Mo CA.SPSS 18.0 software was used to analyze data.According to the kind of data,analysis of variance,rank sum test,or chi-square test were applied for univariate analysis.Multiple stepwiseregression was used for multivariate analysis of the correlative influencing factors of COPD patients with cognitive impairment,P < 0.05 was considered statistically significant.Results The incidence of cognitive impairment assessed by MMSE was about 54.76%,but using Mo CA scale was up to 80.15% in senior patients with COPD.There is significant difference in cognitive dysfunction between patients in mild or moderate stage and severe or very severe stage COPD?P<0.01?,but there was no difference among severe groups and mild-moderate groups assessed by MMSE and Mo CA scales.Assessment with Mo CA,there is difference between patients in stable disease and exacerbations,however,there is no difference when MMSE were used.To appraise each cognitive domain of the senior patients with COPD by MMSE,the memory ability of group A1 is significantly better than those of patients in group A2 and S2?P<0.05?,and group A1 and S1 is better than those in group A2?P<0.05?.The attention ability of group S2 in patients is worse than group A1 and S1?P<0.05?.Assessment with Mo CA,the attention ability of patients in S2 group is significantly worse than group A1 and S1?P<0.01?,and the delayed memory in groups A2 and S2 is significantly weaker than the S1 group?P<0.01?,and the naming ability of group A2 is the worst in all groups?P<0.05?.Multiple stepwise regression shows that the main influencing factors of cognitive dysfunction in group A1 and A2 are duration of COPD and Pa CO₂,and the ones in group S1 and S2 are duration of COPD,the class of medical insurance,Pa O₂,age,and Fe NO?P<0.05?,except Pa CO₂?P>0.05?.According subgroups analysis,the independent factors of cognitive dysfunction in group A1 are educational background?r = 0.405,P = 0.000?and cohabitation?r =0.789,P = 0.048?.The ones in group S1 are educational background?r = 0.297,P = 0.001?and age?r =-0.134,P =0.027?,the ones in group A2 are age?r =-0.248,P = 0.004?and Pa CO₂?r =-0.239,P = 0.001?,and the one in group S2 is duration of COPD?r =-0.226,P = 0.001?.Conclusion 1.The degree of cognitive impairment in severe or very severe stage COPD seniors is heavier than mild or moderate patients,and those in acute exacerbation of COPD may be more severe than those in stable period,Mo CA is superior to MMSE.2.With the deterioration of disease,the abilities to memory and attention decreased as a main in senior COPD patients,and damage of naming ability may help rapid screening of cognitive disorders in severe or very severe and AECOPD senior patients.3.The cognitive disorders of mild-moderate COPD patients are mainly due to the patient's own basic conditions as the risk factors,and severe or very severe patients' cognition are mainly caused by COPD itself;Regarding cognition state of AECOPD seniors,Pa CO₂ is one of influencing factors,but there is a positive relationship with cognition and Pa O₂,not relevant with Pa CO₂ in stable seniors.