COPD and the risk of mild cognitive impairment and dementia: a cohort study based on the Chinese Longitudinal Health Longevity Survey

Risk factors of cognitive frailty in elderly chronic obstructive pulmonary disease patients and its implication for death: a cohort study

BACKGROUNDS

Cognitive frailty, a clinical syndrome with physical frailty and cognitive impairment, leads to mortality and other adverse health outcomes in older adults. This study aimed to investigate the prevalence of cognitive frailty, and its influencing factors, and follow its impact on short-term mortality in elderly chronic obstructive pulmonary disease patients, to provide a theoretical scientific reference basis for clinical intervention and management of cognitive frailty.

METHODS

A sample of 243 elderly chronic obstructive pulmonary disease patients in the respiratory department of a tertiary care hospital was conveniently sampled from November 2021 to February 2023, and the prevalence of cognitive frailty was investigated using the General Information Survey Scale, the Fried Phenotype Scale, the Mini-Mental State Examination, the Anxiety Self-Rating Scale, the Brief Geriatric Depression Scale, and the Mortality Record. The mortality was recorded by telephone follow-up after 6 months. A database was created and statistical analysis such as one-way analysis of variance, logistic regression analysis, Kaplan-Meier, and Cox survival analysis were used to analyze the data.

RESULTS

A total of 47 patients (19.3%) had cognitive frailty; there were statistical differences in the prevalence of cognitive frailty by medical payment type, physical exercise, and sleeping time (P < 0.05). During a 6-month follow-up, 38 patients (15.6%) died. Cox survival analysis showed that the risk of death in elderly chronic obstructive pulmonary disease patients in the cognitive frailty group was 3.212 times higher than that in the normal cognitive function and non-frailty group (95% CI 1.646-6.270, P = 0.001), and 5.266 times higher than that in the normal cognitive function and frailty group (95% CI 3.159-8.778, P < 0.001).

CONCLUSIONS

The prevalence of cognitive frailty in elderly chronic obstructive pulmonary disease patients is high, and clinical staff should pay attention to patients' medical burden and financial ability, and reduce the incidence of cognitive frailty by instructing patients to perform physical exercise and arrange sleep time. Cognitive frailty is an important risk factor for mortality within 6 months in elderly chronic obstructive pulmonary disease patients, and early intervention should be emphasised to reduce or delay cognitive frailty and mortality.

The association of sun-cured tobacco and cigarette use with global cognitive function, verbal fluency and memory in patients with chronic obstructive pulmonary disease: A cross-sectional study

INTRODUCTION

Some elderly people in China prefer sun-cured tobacco to cigarettes, and the composition of sun-cured tobacco and cigarettes is inconsistent. The influence of cigarettes on the cognitive function of COPD patients has been widely reported, but the research on sun-cured tobacco is relatively rare. Our study explored the association of sun-cured tobacco and cigarette use with cognitive decline in COPD patients.

METHODS

This was a cross-sectional study. A total of 401 COPD patients were included, and 190, 103, and 108 participants were included in non-smoking, cigarette-smoking, and sun-cured tobacco groups, respectively. We evaluated the global cognitive function using the Beijing version of the Montreal Cognitive Assessment, verbal fluency function using an animal fluency test, and memory function using ten unrelated words.

RESULTS

The participants of both cigarette-smoking (AOR=11.18; 95% CI: 1.28- 97.5) and sun-cured tobacco (AOR=10.46; 95% CI: 1.14-96.4) groups were more likely to develop mild cognitive impairment compared to the non-smoking group. The mean z scores of global cognitive function, verbal fluency, and memory were lower in cigarette-smoking and sun-cured tobacco groups than those in a non-smoking group; Multivariable linear regression showed that global cognitive function (β= -0.61; 95% CI: -1.04 - -0.18; and β= -0.48; 95% CI: -0.91 - -0.05) and verbal fluency (β= -0.79; 95% CI: -1.33 - -0.26; and β= -0.69; 95% CI: -1.23 - -0.16) of the sun-cured tobacco group and the cigarette-smoking group were significantly lower than those of the non-smoking group when adjusting for demographic and disease-related characteristics. However, there was no significant difference between the cigarette-smoking and sun-cured tobacco groups in global cognitive function, verbal fluency, and memory.

CONCLUSIONS

Compared with non-smokers, the use of cigarettes and sun-cured tobacco may damage the cognitive function of COPD patients, especially in global cognitive function and verbal fluency.

Breathing on the mind: Treating dyspnea and anxiety symptoms with biofeedback in chronic lung disease - A qualitative analysis

RATIONALE

Chronic obstructive pulmonary disease (COPD) is characterized by dysfunctional breathing patterns that contribute to impaired lung function and symptoms of dyspnea, anxiety, and abnormal carbon dioxide (CO2) levels.

OBJECTIVE

The study objective was to measure the acceptability of a new mind-body intervention we developed called Capnography-Assisted, Learned Monitored (CALM) Breathing, implemented before pulmonary rehabilitation.

METHODS

CALM Breathing is a 4-week (8-session) intervention designed to treat dyspnea and anxiety in adults with COPD by targeting dysfunctional breathing behaviors (guided by end-tidal CO2 levels). CALM Breathing consists of ten core breathing exercises, CO2 biofeedback, and motivational interviewing. Using qualitative methods and semi-structured interviews immediately post-intervention, we evaluated the acceptability and participation process of CALM Breathing. Themes were identified using constant comparative analysis.

RESULTS

Sixteen participants were interviewed after receiving CALM Breathing. Three main themes of CALM Breathing were identified: (1) Process of learning self-regulated breathing, (2) Mechanisms of a mind-body intervention, (3) Clinical and implementation outcomes.

CONCLUSIONS

Positive themes supported the acceptability of CALM Breathing and described participants' process of learning more self-regulated breathing to manage their dyspnea and anxiety. Positive signals from qualitative participant feedback provided support for CALM Breathing as an intervention for COPD, but larger scale efficacy trials are needed.

Risks of dementia in a general Japanese older population with preserved ratio impaired spirometry: The Hisayama Study

BACKGROUND

Studies on the association between preserved ratio impaired spirometry (PRISm) and dementia are limited. Indeed, PRISm has often been overlooked or ignored as an index of lung function impairment. Therefore, we investigated the association of PRISm with the risk for the development of dementia in an older Japanese population.

METHODS

A total of 1202 community-dwelling, older Japanese participants aged ≥65 years without dementia were followed up for a median of 5.0 years. Participants were categorized by spirometry as follows: normal spirometry (FEV1/FVC ≥0.70 and FEV1 ≥80% predicted), PRISm (≥0.70 and <80%), airflow limitation (AFL) Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 (<0.70 and ≥80%), and AFL GOLD 2 to 4 (<0.70 and <80%). Hazard ratios (HRs) and their 95% confidence intervals (CIs) were computed using a Cox proportional hazards model.

RESULTS

During the follow-up period, 122 participants developed dementia. The age- and sex-adjusted incidences of dementia in the participants with normal spirometry, PRISm, AFL GOLD 1, and AFL GOLD 2 to 4 were 20.5, 37.0, 18.4, and 28.6 per 1000 person-years, respectively. Participants with PRISm had a higher risk of dementia (HR 2.04 [95%CI, 1.19-3.49]) than those with normal spirometry after adjusting for confounders. Moreover, both reduced FEV1% predicted values and FVC% predicted values were associated with the risk for dementia.

CONCLUSION

PRISm was associated with an increased risk of dementia in a general older Japanese population.

Rural-Urban Differences in Mild Cognitive Impairment Among Patients with Chronic Obstructive Pulmonary Disease in ChengDu, China

Purpose

The rural-urban gap in sociodemographic, lifestyle, and disease-related characteristics among COPD patients is prevalent. These differences may influence the prevalence of mild cognitive impairment (MCI). This study aimed to compare the prevalence and determinants of MCI between rural and urban areas among COPD patients.

Patients and Methods

The cross-sectional study sample comprised 372 COPD patients from China. We evaluated the cognitive function and lung function, collected sociodemographic, lifestyle, and disease-related information, to compare the prevalence of MCI in rural and urban areas. Using multivariate regression analysis to examine the effects of variables to MCI.

Results

The prevalence of MCI in rural areas was higher than that in urban areas (65.4% vs 47.9%, P=0.001). The prevalence in farm laborers was almost twice as high as that of non-farm laborers in urban areas (82.6% vs 43.1%), but no significant difference in rural areas (P=0.066). However, the data were lower in subjects who insisted on long-term home oxygen therapy (39.7%, CI:27.8-51.6, P<0.001), and who with higher monthly household income (49.6%, CI:40.2-58.9) in rural areas, but no significant difference in urban areas (P=0.985 and 0.502). Multivariate logistic regression analysis indicated that participants aged 71 years and above, former smokers were at a high risk of MCI in both urban and rural areas. However, participants who slept for 6-8 hours a day, shopping frequently, or exercised for more than 2 hours a day had a lower risk of MCI in urban areas. But rural participants who insisted on long-term home oxygen therapy had a lower probability of developing MCI.

Conclusion

This study revealed that there were significant differences in MCI among COPD patients in rural and urban areas, especially in exercise, sleeping, shopping, and long-term home oxygen therapy. Medical staff should give health guidance according to the actual situation of patients with COPD.

Trends in prevalence and the effects on hospital outcomes of dementia in patients hospitalized with acute COPD exacerbation

AIMS

To assess changes in prevalence and the effects on hospital outcomes of dementia among patients hospitalized with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD); and to evaluate sex-differences, as well as the impact of COVID-19 pandemic in this relationship.

METHODS

We used a nationwide discharge database to select patients admitted with AE-COPD in Spain from 2011 to 2020. We identified those with any type of dementia, vascular dementia (VaD) or Alzheimer's disease (AD).

RESULTS

We identified 658,429 hospitalizations with AE-COPD (4.45% had any type of dementia, 0.79% VaD and 1.57% AD). The presence of any type of dementia remained stable from 2011 to 2015, and increased significantly between 2016 and 2020. For VaD, the time trend showed no change until 2020, when a significant increment was found. The probability of AD decreased significantly overtime. The in-hospital mortality (IHM) among patients with any type of dementia remained stable overtime until 2020, when it increased significantly. Older age, higher comorbidity, COVID-19, and use of mechanical ventilation were variables associated to IHM. Women had lower risk of dying in the hospital than men in all subgroups.

CONCLUSIONS

After a previous period of stability, the prevalence of any type of dementia increased over the last 5 years of the study, although we identified different trends depending on the specific cause of dementia. The IHM remained stable overtime until 2020, when it increased, probably related to the COVID-19 pandemic. It is remarkable the protective effect of female sex for IHM.

Associations of Lung Function Decline with Risks of Cognitive Impairment and Dementia: A Meta-Analysis and Systematic Review

BACKGROUND

There are controversies surrounding the effects of lung function decline on cognitive impairment and dementia.

OBJECTIVE

We conducted a meta-analysis and systematic review to explore the associations of lung function decline with the risks of cognitive impairment and dementia.

METHODS

The PubMed, EMBASE, and the Cochrane Library were searched to identify prospective studies published from database inception through January 10, 2023. We pooled relative risk (RR) and 95% confidence intervals (CI) using random-effects models. The Egger test, funnel plots, meta-regression, sensitivity, and subgroup analyses were conducted to detect publication bias and investigate the source of heterogeneity.

RESULTS

Thirty-three articles with a total of 8,816,992 participants were subjected to meta-analysis. Poorer pulmonary function was associated with an increased risk of dementia (FEV: RR = 1.25 [95% CI, 1.17-1.33]; FVC: RR = 1.40 [95% CI, 1.16-1.69]; PEF: RR = 1.84 [95% CI, 1.37-2.46]). The results of the subgroup analyses were similar to the primary results. Individuals with lung diseases had a higher combined risk of dementia and cognitive impairment (RR = 1.39 [95% CI, 1.20-1.61]). Lung disease conferred an elevated risk of cognitive impairment (RR = 1.37 [95% CI, 1.14-1.65]). The relationship between lung disease and an increased risk of dementia was only shown in total study participants (RR = 1.32 [95% CI, 1.11-1.57]), but not in the participants with Alzheimer's disease (RR = 1.39 [95% CI, 1.00-1.93]) or vascular dementia (RR = 2.11 [95% CI, 0.57-7.83]).

CONCLUSION

Lung function decline was significantly associated with higher risks of cognitive impairment and dementia. These findings might provide implications for the prevention of cognitive disorders and the promotion of brain health.

Associations Between Cognitive Function, Balance, and Gait Speed in Community-Dwelling Older Adults with COPD

BACKGROUND AND PURPOSE

Older adults with chronic obstructive pulmonary disease (COPD) are at risk for physical and cognitive impairment. Cognitive function is associated with falls in older adults. However, it is unknown whether a relationship exists between cognitive function and falls in patients with COPD. The aim of this study was to examine the relationships between cognitive function, balance, and gait speed in older adults with COPD.

PATIENTS AND METHODS

A secondary analysis was performed using data from the 2010 wave of the Health and Retirement Study (HRS). Cognitive (immediate and delayed recall, executive function) and physical (gait speed, tandem balance time) measure data were extracted for older adults with COPD (n = 382) and an age-matched control group without COPD (n = 382) who met inclusion/exclusion criteria. Multivariate linear regression modeling was performed to examine associations between cognitive function and mobility or balance while controlling for age, gender, body mass index, grip strength, and education.

RESULTS

In older adults with COPD, delayed recall was significantly associated with tandem balance performance (β= 1.42, P < .05). Other cognitive measures were not associated with gait speed or balance.

CONCLUSION

In older adults with COPD, one of four cognitive functions was associated with a static standing balance task. Screening of cognitive function, specifically delayed recall, should be a part of the management of falls in this population.

Prevalence and associated factors of cognitive impairment among the elderly population: A nationwide cross-sectional study in China

Background

Cognitive impairments are associated with increased risk for progression to dementia. In China, limited surveys have been conducted to estimate the national prevalence and risk factors associated with cognitive impairment in China. This study aims to assess the national prevalence and modifiable risk factors for cognitive impairments in the Chinese elderly population.

Methods

This cross-sectional study was based on the 2018 China Health and Retirement Longitudinal Study. The Mini Mental State Examination (MMSE) is recommended to test for cognitive impairment. Univariate and multivariate logistic regression models were used in assessing risk factors for cognitive impairments in the Chinese elderly population.

Results

A total of 3768 participants aged 60 years or older were enrolled in this study. The national prevalence of cognitive impairments was 22.24% in China, and the prevalence of cognitive impairment was higher in the south-west region than in the north region (29.94 vs. 16.53%, p < 0.05). The risk for cognitive impairments was higher in the following participants: not married or not living with spouse relative to married with spouse present (OR = 1.39, 95% CI, 1.15-1.70; p = 0.001), nap duration of ≥ 90 min relative to 30-60 min (OR = 1.54, 95% CI, 1.20-1.98; p = 0.001), sleep duration of ≥ 8 h relative to 6-8 h (OR = 1.73, 95% CI, 1.29-2.31; p < 0.001), and depression relative to no depression (OR = 1.67, 95% CI, 1.41-1.97; p < 0.001). The risk of cognitive impairment was lower in participants living in the urban areas relative to the rural areas (OR = 0.57, 95% CI, 0.47-0.69; p < 0.001) and consuming alcohol once a month relative to never consuming alcohol (OR = 0.69, 95% CI, 0.51-0.94; p = 0.02).

Conclusion

Cognitive impairment prevalence was high in the Chinese elderly population. The potentially modifiable risk factors for cognitive impairment should be further assessed in the development of interventions for the elderly Chinese population.

Association between pulmonary ventilatory function and mild cognitive impairment: A population-based study in rural China

Background

Mild cognitive impairment (MCI), a reversible intermediate state, plays an important role in the development and prevention of dementia. The relationship between pulmonary function and MCI risk has not yet been well-elucidated.

Methods

We included 2,947 rural Chinese residents aged ≥35 years who were free from a history of stroke, dementia, or other brain diseases and measured pulmonary ventilatory function using calibrated spirometry according to the recommended method. MCI was assessed with the Montreal Cognitive Assessment-Basic for Chinese scale. Logistic regression models and restricted cubic splines with covariate adjustment were performed to explore the association between pulmonary function and MCI risk.

Results

The prevalence of MCI increased with decreasing pulmonary function, from the lowest quartile to the highest quartile of pulmonary function: 63.9, 50.5, 43.8, and 43.6%, respectively. After adjustment for confounding factors, participants in the first quartile had a significantly increased risk of MCI (ORs, 1.691, 95% CI, 1.267-2.258), with the highest quartile as the reference. In the subgroup analysis, a significant association of pulmonary function and MCI was found in females and those with low physical activity. Meanwhile, we observed an L-shaped relationship between pulmonary function and MCI (P _non-linear = 0.032).

Conclusions

Poor pulmonary function was associated with an increased risk of MCI among rural Chinese adults, and presented a non-linear relationship. These findings remind us of the need for early cognitive assessment in local populations with lower pulmonary function.

Relationship between chronic obstructive pulmonary disease and cognition in an aging population

OBJECTIVES

Chronic obstructive pulmonary disease (COPD) is a common and severe respiratory illness. Prior research suggests that COPD may be associated with depression as well as cognitive impairment and increased risk of dementia. Many studies to date have been relatively small, have largely relied on global screening measures to identify cognitive impairment, and have not examined the potential role of comorbid depression on cognition. This cross-sectional study examined the relationship between COPD and multiple cognitive domains at two time points using data from a large longitudinal population database.

METHODS

Linear multivariate analyses were conducted using secondary data from the Wisconsin Longitudinal Study to determine the effect of lifetime COPD and depressive symptom severity, assessed with the Center for Epidemiological Studies Depression Scale (CESD), on multiple cognitive outcomes.

RESULTS

In both 2004 (n = 1608) and 2011 (n = 1743), lifetime COPD was found to be a non-significant predictor of all cognitive outcomes, while depressive symptom severity predicted significantly lower scores on the immediate recall and digit ordering tasks in 2004 and on all outcomes in 2011. Exploratory analyses in only those with lifetime COPD revealed COPD severity to be a non-significant factor for all outcomes in 2004 and 2011.

CONCLUSION

COPD was not significantly associated with cognition. Conversely, higher depressive symptom severity was significantly associated with poorer performance on additional cognitive tasks in 2011 compared to 2004, suggesting that depression may contribute to cognitive decline, dependent upon the context of aging.

Risk of dementia or cognitive impairment in COPD patients: A meta-analysis of cohort studies

Purpose

A meta-analysis of cohort studies was performed to evaluate the association between COPD and the risk of dementia or cognitive impairment.

Methods

Cohort studies that evaluated the association between COPD and the risk of dementia or cognitive impairment were identified by a systematic search of PubMed, Embase, Web of Science, and Cochrane Library databases. The search time frame was from database establishment to April 12, 2022, with two reviewers independently screening the literature and extracting data. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to conduct the quality evaluation. Then, a meta-analysis was performed using Stata 15.1 software.

Results

Six cohort studies including 428,030 participants were included. The overall quality of the included studies was high, with an average NOS score of over 7. Meta-analysis showed that compared to those without COPD at baseline, patients with COPD were associated with a significant increased risk of dementia (RR = 1.24, 95% CI = 1.03 ~ 1.50, I2 = 96.6%, z = 2.25, p = 0.024) and cognitive impairment (RR = 1.30, 95% CI = 1.13 ~ 1.49, I2 = 50.1%, z = 3.72, p &lt; 0.001). Subgroup analysis suggested no significant difference in the risk of dementia among COPD patients of different genders. Nevertheless, in terms of age, the risk of dementia varied among COPD patients of different ages, which was most distinguished in patients younger than 65 years.

Conclusion

COPD patients have a higher risk of developing dementia or cognitive impairment compared to those without COPD, and this risk is not affected by gender but seems to be associated with age.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022325832.

Pulmonary function is associated with cognitive decline and structural brain differences

The association of poor pulmonary function (PF) with cognitive trajectories and structural brain differences remains unclear. Within the Rush Memory and Aging Project, 1377 dementia-free subjects were followed up to 21 years. PF was assessed with a composite score measured at baseline. Global and domain-specific cognitive function was assessed annually constructed from 19 cognitive tests. A subsample of 351 participants underwent brain magnetic resonance imaging to investigate the cross-sectional association between PF and structural brain volumes. We found that low PF was related to faster decline in global cognition, and domain-specific function including episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed. In addition, low PF was associated with smaller volumes of total brain, white matter and gray matter, and larger white matter hyperintensities volume. Our results suggest that low PF is associated with faster cognitive decline, and both neurodegeneration and vascular brain lesions may underlie the association.

Risk of developing cognitive impairment on patients with chronic obstructive pulmonary disease: A systematic review

BACKGROUND

The increasing number of chronic obstructive pulmonary disease (COPD) incidence has led to a great negative impact on older people's lives. This chronic disease was a critical and independent risk factor for cognitive function impairment in the elderly with mild cognitive impairment as a frequent feature. This systematic review aimed to examine the risk of developing cognitive impairment in COPD.

METHODS

A structured search of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement guideline, with a pre-determined search strategy starting from study identification, title and abstract screening, eligibility assessment, and inclusion of relevant study. The search was conducted in PubMed and MEDLINE via EBSCOhost, with restriction to human studies. The studies from inception until January 12, 2021.

RESULTS

Five original articles were included. Most studies found that patients with COPD had a higher chance of developing cognitive impairment, especially when patients were followed up for more than 5 years. We discovered that the risk of cognitive impairment seemed to be correlated with the length of time spent following the participants, with the highest risk of cognitive impairment being identified in those who had the longest observation period. It is critical to conduct cognitive screening from the time a diagnosis of COPD is obtained and on a continuing basis in order to recognize and treat these individuals appropriately.

CONCLUSION

There is a potential association between COPD and mild cognitive impairment. We encourage more studies to be done with higher sensitivity and specificity cognitive screening tools in the future to build better evidence and qualify to be analyzed quantitatively with meta-analysis.

Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia risk: A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common public health issue that has been linked to cognitive dysfunction.

AIM

To investigate the relationship between COPD and a risk of mild cognitive impairment (MCI) and dementia.

METHODS

A comprehensive literature search of the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases was conducted. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random or fixed effects model. Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.

RESULTS

Twenty-seven studies met all the inclusion criteria. Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence (OR = 2.11, 95%CI: 1.32-3.38). It also revealed a borderline trend for an increased dementia risk in COPD patients (OR = 1.16, 95%CI: 0.98-1.37). Pooled hazard ratios (HR) using adjusted confounders also showed a higher incidence of MCI (HR = 1.22, 95%CI: -1.18 to -1.27) and dementia (HR = 1.32, 95%CI: -1.22 to -1.43) in COPD patients. A significant lower mini-mental state examination score in COPD patients was noted (MD = -1.68, 95%CI: -2.66 to -0.71).

CONCLUSION

Our findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients. Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.

Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care

The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.

Prevalence of Dementia in China in 2015: A Nationwide Community-Based Study

Objective: This study aims to estimate the prevalence of dementia and Alzheimer's disease (AD) and associated risk factors among the general Chinese population.

Methods: We carried out a nationwide study including 24,117 participants aged 60 years and older in China using a multistage clustered sampling. Dementia and AD were diagnosed according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and the criteria issued by the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association. Face-to-face interviews were administered by the trained interviewers to obtain information on demographics, lifestyle factors, and previous diseases.

Results: The overall weighted prevalence of dementia was 4.22% (95%CI 2.27–6.17%) for people aged 60 years and older, was higher in women than in men and increased with age. Daily tea drinking and daily exercises were the protective factors for both dementia and AD. Engaging in social and intellectual activities was significantly associated with a lower risk of dementia and AD.

Conclusions: A large number of population with dementia posed a significant challenge to China where the population is rapidly aging. The increase of public awareness, building more care facilities, and training dementia specialists and professional caregivers are all urgently needed and should be the future priorities of dementia care in China.

Factors affecting brain structure in smoking-related diseases: Chronic Obstructive Pulmonary Disease (COPD) and coronary artery disease

Background

Changes in brain structure and cognitive decline occur in Chronic Obstructive Pulmonary Disease (COPD). They also occur with smoking and coronary artery disease (CAD), but it is unclear whether a common mechanism is responsible.

Methods

Brain MRI markers of brain structure were tested for association with disease markers in other organs. Where possible, principal component analysis (PCA) was used to group markers within organ systems into composite markers. Univariate relationships between brain structure and the disease markers were explored using hierarchical regression and then entered into multivariable regression models.

Results

100 participants were studied (53 COPD, 47 CAD). PCA identified two brain components: brain tissue volumes and white matter microstructure, and six components from other organ systems: respiratory function, plasma lipids, blood pressure, glucose dysregulation, retinal vessel calibre and retinal vessel tortuosity. Several markers could not be grouped into components and were analysed as single variables, these included brain white matter hyperintense lesion (WMH) volume. Multivariable regression models showed that less well organised white matter microstructure was associated with lower respiratory function (p = 0.028); WMH volume was associated with higher blood pressure (p = 0.036) and higher C-Reactive Protein (p = 0.011) and lower brain tissue volume was associated with lower cerebral blood flow (p<0.001) and higher blood pressure (p = 0.001). Smoking history was not an independent correlate of any brain marker.

Conclusions

Measures of brain structure were associated with a range of markers of disease, some of which appeared to be common to both COPD and CAD. No single common pathway was identified, but the findings suggest that brain changes associated with smoking-related diseases may be due to vascular, respiratory, and inflammatory changes.

Cooking with biomass fuels increased the risk for cognitive impairment and cognitive decline among the oldest-old Chinese adults (2011-2018): A prospective cohort study

BACKGROUNDS

While the pernicious effects of outdoor air pollution on cognitive ability have been previously examined, evidence regarding household air pollution is scarce.

METHODS

Using data from the Chinese Longitudinal Healthy Longevity Survey, we explored the relationship between cooking with biomass fuel and cognitive impairment and cognitive decline using a Cox proportional hazards model. We further assessed the correlation of biomass fuels and cognitive score using a generalized estimating equation. Cognitive ability was measured based on the Chinese version of the Mini-Mental State Examination (MMSE) and cognitive impairment was defined as MMSE < 24 points and cognitive decline was defined as a reduction of MMSE ≥ 3 points. On follow-up, we investigated the effect of switch-cooking combustibles on cognitive ability.

RESULTS

The mean (SD) age of 4161 participants was 81.7 (10.0) years old. The reported cooking with biomass fuels was correlated with an elevated risk of cognitive impairment (hazard ratio (HR): 1.19, 95% confidence interval (CI): 1.04, 1.37) and cognitive decline (HR: 1.18, 95% CI: 1.04, 1.33). Besides, cooking with biomass fuels was related to a decrease in cognitive score (β: -0.43, 95% CI: -0.73, -0.14). In comparison to persistent biomass fuel users, participants who reported changing their primary cooking fuels from biomass to clean fuels exhibited a reduced risk of cognitive impairment (HR: 0.68, 95% CI: 0.57, 0.82) and cognitive decline (HR: 0.66, 95% CI: 0.56, 0.76) and a higher cognitive score (β: 0.72, 95% CI: 0.17, 1.26). Cooking without ventilated cookstoves was associated with a higher risk of cognitive impairment (HR: 1.31, 95% CI: 1.10, 1.58) and cognitive decline (HR: 1.18, 95% CI: 1.02, 1.38), regardless of types of cooking fuels. Interaction and stratified analyses showed relatively poor cognitive ability in participants who engaged in irregular exercise or were not living with family members.

CONCLUSIONS

Cooking with biomass fuels was correlated with a higher risk of cognitive impairment and cognitive decline. Among the oldest-old population, this risk may, however, be lower for those changing their primary cooking fuels from biomass to clean fuels.

Risk of incident dementia and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD): A large UK population-based study

BACKGROUND

Although cognitive impairment and dementia are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), estimates of incidence following a diagnosis of COPD are inconclusive.

OBJECTIVE

To determine the incidence of cognitive impairment and dementia in people with and without a COPD diagnosis.

METHODS

A population-based study using UK General Practice (GP) health records from The Health Improvement Network database was conducted. Patients with confirmed COPD diagnosis, ≥40 years old, were matched to up to four subjects without a COPD diagnosis by age, sex and GP practice. Cox proportional hazards models were used to assess the incidence rates of cognitive impairment and dementia.

RESULTS

Of patients with COPD (n = 62,148), 9% developed cognitive impairment, compared with 7% of subjects without COPD (n = 230,076), p < 0.001. The incidence of cognitive impairment following COPD diagnosis was greater than in subjects without COPD following index date (adjusted Hazard Ratio (aHR), 1.21; 95% CI: 1.16 ─ 1.26, p < 0.001). The coded incidence of either cognitive impairment or dementia was also greater in patients with COPD following adjustment for confounders (aHR: 1.13, 95% CI: 1.09 ─ 1.18, p < 0.001). Coded incident dementia alone was not different between patients with COPD and subjects without COPD (aHR, 0.91, 95% CI: 0.83 ─ 1.01, p = 0.053).

CONCLUSION

Despite the increased incidence of cognitive impairment in patients with COPD, incidence of dementia was not as frequently recorded in patients with COPD. This raises the concern of undiagnosed dementia and emphasises the need for a systematic assessment in this population.

Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study

Introduction: We evaluated risk factors and demographic characteristics of associated with mild cognitive impairment (MCI) in patients with COPD. Methods: 220 individuals with COPD enrolled in a cohort study designed to evaluate anxiety conducted at 16 clinical centers. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA), a cutoff score of <26 defined as MCI. Data were collected including spirometry, 6-minute walk test, symptom burden by COPD Assessment Test and dyspnea by Modified Medical Research Council, anxiety measured by Anxiety Inventory of Respiratory Disease, Generalized Anxiety Disorder-7 and Hospital Anxiety Depression Scale, depression by Patient Health Questionnaire-9 and health status by Patient Reported Outcomes Measurement Information System and sleep quality by the Pittsburg Sleep Quality Index. Results: The median age was 65 years and 54% of participants were male. 119(54%) of participants had MCI as classified by MoCA. In multivariable logistic regression, higher odds ratios (OR) (95% confidence interval) for MCI (MoCA) <26 were associated with increased years of age, 1.06 (1.02 -1-09, p<0.003); African-American race, 3.68(1.67-8.11, p<0.001); persistent phlegm, 2 (1.12-3.57, p<0.01) and sleep disturbance, 1.04(1.01-1.08, p<0.01). Conclusions: COPD patients commonly screen positive for MCI. Characteristics associated with MCI included age, African-American race, sleep disturbance and persistent phlegm.

Influence of Comorbidities on the Survival of COPD Patients According to Phenotypes

Background

Chronic obstructive pulmonary disease (COPD) usually occurs alongside other conditions. Few studies on comorbidities have taken into account the phenotypes of COPD patients. The objective of this study is to evaluate the prevalence of comorbidities included in the Charlson index and their influence on the survival of patients with COPD, taking phenotypes into account.

Methods

An observational study was conducted on a group of 273 patients who had COPD and underwent spirometry in the first half of 2011, with a median prospective follow-up period of 68.15 months. The survival of these patients was analyzed according to the presence of various comorbidities.

Results

Of the 273 patients, 93 (34.1%) died within the follow-up period. An increased presence of chronic ischemic heart disease (CIHD), chronic heart failure (CHF), chronic kidney disease (CKD), and malignancy was found in deceased patients. All of these conditions shorten the survival of COPD patients globally; however, when considering phenotypes, only CHF influences the exacerbator with chronic bronchitis phenotype, CKD influences the non-exacerbator phenotype, and malignancy influences the positive bronchodilator test (BDT) and exacerbator with chronic bronchitis phenotypes. In the multivariate model, advanced age (hazard ratio, HR: 1.05; p=0.001), CHF (HR: 1.74; p=0.030), and the presence of malignancy (HR: 1.78; p=0.010) were observed as independent mortality risk factors.

Conclusion

The survival is shorter in the presence of CIHD in overall COPD patients and also CHF, CKD, and malignancy for certain phenotypes. It is important to pay attention to these comorbidities in the comprehensive care of COPD patients.

Respiratory Disease and Lower Pulmonary Function as Risk Factors for Dementia: A Systematic Review With Meta-analysis

BACKGROUND

In addition to affecting the oxygen supply to the brain, pulmonary function is a marker of multiple insults throughout life (including smoking, illness, and socioeconomic deprivation). In this meta-analysis of existing longitudinal studies, the hypothesis that lower pulmonary function and respiratory illness are linked to an elevated risk of dementia was tested.

METHODS

A systematic review was conducted of longitudinal studies using PubMed until April 1, 2019, and, where possible, results were pooled in random effects meta-analyses.

RESULTS

Ten studies relating pulmonary function to later dementia risk and 11 studies of respiratory illness and dementia (including one that assessed both factors) were identified. The lowest quartile of FEV₁ compared with the highest was associated with a 1.4-fold (hazard ratio [HR], 1.46; 95% CI, 0.77-2.75) increased dementia risk (N_total = 62,209; two studies). A decrease of 1 SD in FEV₁ was associated with a 28% increase in dementia risk (HR, 1.28; 95% CI, 1.03-1.60; N_total = 67,505; six studies). Respiratory illness was also associated with increased dementia risk to a similar degree (pooled HR, 1.54; 95% CI, 1.30-1.81; N_total = 288,641; 11 studies).

CONCLUSIONS

Individuals with poor pulmonary function experience an increased risk of dementia. The extent to which the association between poor pulmonary function and dementia is causal remains unclear and requires examination.