Mild Cognitive Impairment in Moderate to Severe COPD: A Preliminary Study

doi:10.1378/chest.11-3035

Chest

Volume 142, Issue 6, December 2012, Pages 1516-1523

https://doi.org/10.1378/chest.11-3035 Get rights and content

Background

Cognitive impairment is a frequent feature of COPD. However, the proportion of patients with COPD with mild cognitive impairment (MCI) is still unknown, and no screening test has been validated to date for detecting MCI in this population. The goal of this study was to determine the frequency and subtypes of MCI in patients with COPD and to assess the validity of two cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in detecting MCI in patients with COPD.

Methods

Forty-five patients with moderate to severe COPD and 50 healthy control subjects underwent a comprehensive neuropsychologic assessment using standard MCI criteria. Receiver operating characteristic curves were obtained to assess the validity of the MMSE and the MoCA to detect MCI in patients with COPD.

Results

MCI was found in 36% of patients with COPD compared with 12% of healthy subjects. Patients with COPD with MCI had mainly the nonamnestic MCI single domain subtype with predominant attention and executive dysfunctions. The optimal MoCA screening cutoff was 26 (≤ 25 indicates impairment, with 81% sensitivity, 72% specificity, and 76% correctly diagnosed). No MMSE cutoff had acceptable validity.

Conclusions

In this preliminary study, a substantial proportion of patients with COPD were found to have MCI, a known risk factor for dementia. Longitudinal follow-up on these patients is needed to determine the risk of developing more severe cognitive and functional impairments. Moreover, the MoCA is superior to the MMSE in detecting MCI in patients with COPD.

Section snippets

Patient Selection

Patients with COPD were prospectively enrolled and referred by a pneumologist from the outpatient COPD clinic at the Hôpital du Sacré-Coeur de Montréal. The inclusion criteria were: (1) clinically stable moderate to severe COPD according to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification,¹⁵ (2) postbronchodilation FEV₁ < 80% of the predicted normal value and FEV₁ to FVC ratio < 0.7, (3) age ≥ 40 years, and (4) smoking history of ≥ 10 American pack-years (20

Results

Of the 53 patients with COPD invited to participate in the study, eight were excluded (five refused, one for concomitant schizophrenia, one for alcoholism, and one for native language other than French or English), for a final sample of 45 patients with COPD (Table 2 for sociodemographic and clinical characteristics). No significant differences were found between patients with COPD and control subjects for age, sex, educational level, or excessive daytime sleepiness (Epworth Sleepiness Scale

Discussion

The main finding of this study was that patients with moderate to severe COPD are at high risk for MCI, with an estimated 36% frequency. This is significantly higher than the proportion of MCI found in healthy control subjects matched for age, sex, education, and severity of excessive daytime sleepiness. Moreover, we found convincing evidence that the MoCA is a more reliable screening test than the MMSE in detecting MCI in patients with COPD.

Acknowledgments

Author contributions: Drs Villeneuve, Pepin, and Gagnon are guarantors of the article.

Dr Villeneuve: contributed to data acquisition, analysis, and interpretation; wrote the first draft of the manuscript; and revised it following critical reviews by the coauthors.

Dr Pepin: contributed to study design, data acquisition and interpretation, study coordination, and fundraising and critically reviewed the manuscript.

Mr Rahayel: contributed to data acquisition and analysis and critically reviewed the

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Funding/Support: This study was supported by grants from the Fonds de recherche du Québec-Santé (Drs Pepin and Gagnon), the Canadian Lung Association/Canadian Respiratory Health Professionals (Dr Pepin), the Faculté des sciences humaines de l'Université du Québec à Montréal (Dr Gagnon), and the Réseau provincial de recherche en adaptation-réadaptation (scholarship to Mr Rahayel).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

View full text

Chest

Original ResearchCOPDMild Cognitive Impairment in Moderate to Severe COPD: A Preliminary Study

Background

Methods

Results

Conclusions

Section snippets

Patient Selection

Results

Discussion

Acknowledgments

Lancet

Chest

Lancet

Neuropsychologia

J Psychiatr Res

Arch Clin Neuropsychol

Arch Clin Neuropsychol

Alzheimers Dement

Lancet Neurol

Psychiatry Res

Neuropsychologia

Ageing Res Rev

Global burden of COPD: systematic review and meta-analysis

Eur Respir J

Cognitive function in COPD

Eur Respir J

Drawing impairment predicts mortality in severe COPD

Chest

Mild cognitive impairment as a clinical entity and treatment target

Arch Neurol

Vascular risk factors, incidence of MCI, and rates of progression to dementia

Neurology

Detection of mild cognitive impairment using cognitive screening tests: a critical review and preliminary data on the Mattis Dementia Rating Scale

The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment

J Am Geriatr Soc

The MoCA: well-suited screen for cognitive impairment in Parkinson disease

Neurology

The Montreal Cognitive Assessment: a screening tool for mild cognitive impairment in REM sleep behavior disorder

Mov Disord

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary

Am J Respir Crit Care Med

DSM-IV-TR

Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision

Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal

Eur Respir J Suppl

Original Research
COPD
Mild Cognitive Impairment in Moderate to Severe COPD: A Preliminary Study