Prevalence and Risk Factors of Cognitive Impairment in COPD: A Systematic Review and Meta-Analysis.

Objective Cognitive impairment is a common comorbidity, yet overlooked, in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the current practice and perceptions of physicians on recognising and managing cognitive impairment in patients with COPD in Saudi Arabia. This study aimed to investigate current practices and perceptions of physicians in Saudi Arabia regarding the recognition and management of cognitive impairment in COPD patients. Methods An online cross-sectional questionnaire was distributed between March and October 2023 to physicians in Saudi Arabia. The collected responses were analysed using descriptive statistics. Results A total of 808 physicians completed the online survey. Of whom, only 19% indicated receiving adequate training for managing cognitive impairment. Although the vast majority of physicians reported that cognitive impairment leads to underestimation of COPD severity (85%) and interferes with self-management (85%), only 11% agreed on the important role of screening. In addition, only half of the study participants aimed to identify possible cognitive impairment, with only 4% screening for cognitive impairment during patients’ assessment. The overall confidence level in recognising and managing cognitive impairment was relatively low. The most common barriers contributing to the suboptimal management of cognitive impairment in COPD were poor training (62%), the absence of standardised procedures (63%) and limited knowledge (58%) about cognitive impairment in COPD. Conclusion The current practice of recognising and managing cognitive impairment in Saudi Arabia is suboptimal. This is likely to be attributed to inadequate training, the absence of standardised procedures, and limited knowledge about cognitive impairment in COPD. Healthcare systems should provide more training and implement a holistic approach to detect and manage cognitive impairment during patients’ visits.

Assessment of Cognitive Impairment in Patients with Chronic Obstructive Pulmonary Disease Using the Rapid Cognitive Screen.

Factor-Associated Risk Factors of Mild Cognitive Impairment in Thalassemia Patients : Probable Role of FGF21

A Clinical Approach to Mild Cognitive Impairment

Background: Cognitive impairments are common in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). To date there are no meta- analyses that have investigated the prevalence of mild cognitive impairment (MCI) in patients with COPD and CHF. Aims: To examine the individual study data set using meta-analysis to estimate the prevalence of MCI in patients with COPD and CHF. Methods Data sources: We identified relevant studies for COPD and CHF by searching published literature from inception to February 2016 using the MEDLINE and Web of Science databases. Study selection: Studies were included if they documented the prevalence of MCI and CHF for patients without dementia and employed appropriate screening tool for cognitive impairment. Data extraction and synthesis: 17 studies of CHF patients (n= 29,456) and 14 studies of COPD patients (n= 23, 116) were included for the meta-analysis. Main outcome measures : Prevalence of MCI in patients with COPD and CHF. The pooled prevalence of MCI for patients with COPD was estimated at 24% (95% CI: 12%, 38%). The prevalence of MCI in patients with CHF was 35% (95% CI: 25%, 45%). In the jackknife sensitivity analysis, both pooled estimates did not substantially vary when the meta-analysis was repeated with each included study being excluded one at a time. Conclusions: Approximately, 24% COPD patients and 35% CHF patients respectively had MCI. Studies are needed to examine the efficacy of intervention on MCI.

Background: Impairment of cognitive function is reported to be a significant comorbidity of Chronic Obstructive Pulmonary Disease, which can have a negative effect on clinical outcomes.Objective: To investigate the prevalence of mild cognitive impairment (MCI) among Thai COPD patients and related factors. Materials and Methods:The cross-sectional study enrolled severe COPD patients in outpatient units (COPD registry) between September 2022 and December 2023.To assess cognitive function, the Thai version of the Rowland Universal Dementia Assessment Scale (RUDAS-Thai) was performed.Descriptive statistics were used to analyze characteristic data.Univariate and multivariate analyses were used to evaluate the variables associated with cognitive impairment among participants.Results: A total of 40 participants were recruited for the present study, with 92.5% identifying as male.The median age was 72 years (IQR 65 to 78).The median score on the COPD Assessment Test (CAT) was 9.95 (IQR 3.75 to 15).Additionally, 50% of the participants had a history of severe acute exacerbations in recent years.The prevalence of mild cognitive impairment (MCI) was 57%, with a median RUDAS-Thai score of 25 (IQR 24 to 27.25).There was a significant correlation between a history of severe acute exacerbations and MCI (OR 7.42, 95% CI 1.91 to 34.69).However, no correlation was found between symptom scores and lung function in patients with MCI. Conclusion:MCI was commonly observed among COPD patients, and severe acute exacerbations were associated with MCI.The screening of MCI in patients with COPD should be recommended as part of the treatment plan.

Objectives Chronic Obstructive Pulmonary Disease (COPD) remains a serious public health problem globally, and the mortality rate for older COPD patients with cognitive impairment is almost three times that of older patients with cognitive impairment or COPD. The aim of this study was to construct a nomogram prediction model for the risk of comorbid cognitive impairment in COPD patients and to evaluate its clinical application. It helps to detect cognitive impairment in COPD patients at an early stage and give them effective interventions in time, so as to delay the progression of COPD patients and improve their prognosis. Methods In this study, COPD patients hospitalised at the North China University of Science and Technology Affiliated Hospitalwere evaluated by the Montreal cognitive assessment (MoCA) scale for cognitive function, and divided into a case group and a control group on the basis of whether or not they were combined with cognitive impairment. Based on the basic characteristics of the patients and the laboratory indexes in the first 24 hours of hospitalisation, we conducted statistical analyses, screened out the risk factors and established the Nomogram Prediction Model by using the R software, and finally, we evaluated the clinical value of the model through the calculation of ROC curves for sensitivity, specificity and kappa value. Finally, the sensitivity, specificity and Kappa value were calculated by ROC curve to evaluate the clinical value of the model. Results After statistical analysis, C-reactive protein (CRP) and homocysteine (Hcy) were found to be the risk factors for combined cognitive impairment in COPD patients, and the Nomogram prediction model was constructed by combining CRP and Hcy and plotted the ROC curve, and it was found that its model finally screened the critical value of the total score of 62.55, and the area under the ROC curve of the model was 0.870, and the sensitivity was 84.7%, and the specificity was 80.4%, indicating that it has a high degree of consistency with the actual results. The area under the ROC curve of this model was 0.870, the sensitivity was 84.7%, the specificity was 80.4%, and the calculated Kappa value was 0.575, which indicated that the consistency between the prediction results and the actual results was better, and it had a higher clinical application value. Conclusions CRP and Hcy are closely associated with comorbid cognitive impairment in COPD patients, and increased levels of CRP and Hcy are associated with an increased risk of comorbid cognitive impairment in COPD patients. Combining both CRP and Hcy to create a nomogram model for predicting comorbid cognitive impairment in patients with COPD has good predictive ability.

Background and Objectives: Despite the significant impacts of cognitive impairment on patients with chronic obstructive pulmonary disease (COPD), there is limited information available on healthcare workers' (HCWs) perceptions, current practice, and barriers to managing COPD patients with cognitive impairment. Materials and Methods: A cross-sectional questionnaire was distributed to HCWs in Saudi Arabia between April and December 2023. The collected responses were analysed using descriptive statistics and logistic regression models. Results: A total of 890 participants, including nursing, physical, and respiratory therapists, completed the online questionnaire. Over two-thirds of the study participants indicated not having sufficient knowledge or adequate training in managing cognitive impairment in patients with COPD. The majority of HCWs perceive cognitive impairment to underdiagnose COPD (83%), underestimate COPD severity (81%), exacerbate COPD symptoms (80%), and interfere with self-management (81%) and pulmonary rehabilitation (81%). However, less than 45% (n = 394) reported having the potential to recognise signs of cognitive impairment during patient encounters. Logistic regression analysis revealed that male healthcare practitioners were more likely to recognise cognitive impairment than females (OR: 1.48; 95% CI: 1.13 to 1.95; p < 0.001). Physical and respiratory therapists were more likely to identify cognitive impairment compared to nurses. Additionally, having more years of experience (≥10 years, OR: 1.63; 95% CI: 1.02 to 2.61; p = 0.001) and adequate knowledge of cognitive impairment (OR: 6.23; 95% CI: 4.18 to 9.29; p = 0.001) were strongly associated with better recognition. Confidence in managing cognitively impaired COPD patients was low, attributed to poor training (64%), inadequate knowledge (64%), and the absence of standardised procedures (58%). Conclusions: HCWs agreed upon the negative impacts associated with cognitive impairment in patients with COPD. However, the potential of recognising signs of cognitive impairment and confidently dealing with the existence of cognitive impairment in COPD is not optimal, owing to poor training and limited knowledge. A focus should be given to managing comorbidities alongside COPD.

Should ‘C’ in COPD Stand for ‘Cognition’?

Objectives To investigate the risk factors for cognitive impairment in Chinese type 2 diabetes mellitus (T2DM) patients of advanced age and to identify effective biomarkers of mild cognitive impairment (MCI) in these patients. Methods Chinese T2DM patients (n = 120) aged 50–70 years were divided into groups with impaired (mild, moderate, and severe) and normal cognitive function based on Montreal Cognitive Assessment and Mini-Mental State Examination scores. Data regarding demographic characteristics, clinical features of diabetes, biochemical markers, and metabolomics were collected. Results Age, educational level, duration of diabetes, fasting blood glucose (FBG), HbA1c, total cholesterol (TC), triglyceride (TG), and 24-hour urine protein were significantly associated with cognitive impairment in T2DM patients of advanced age. The severity of fundus retinopathy and the incidence of macrovascular disease also differed significantly among the groups (P < 0.05). Metabolomics analysis suggested that increased levels of glutamate (Glu), phenylalanine (Phe), tyrosine (Tyr), proline (Pro), and homocysteine (Hcy) and a decreased level of glutamine (Gln) were significantly associated with cognitive impairment in the T2DM patients (P < 0.05). Receiver operating characteristic curve analysis demonstrated that Glu, Gln, Phe, and Pro levels were significant predictors of cognitive impairment in the T2DM patients. Conclusions Age, educational level, duration of diabetes, and the levels of FBG, HbA1c, TC, TG, and 24-hour urine protein were considered as independent risk factors for cognitive impairment in older T2DM patients. Macrovascular and microvascular diseases also were closely associated with cognitive impairment in these patients. Together, Glu and Gln levels may represent a good predictive biomarker for the early diagnosis of cognitive impairment in T2DM patients.

Cognitive Impairment in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: A Systematic Review and Meta-analysis of Observational Studies

Increased detection of mild cognitive impairment with type 2 diabetes mellitus using the Japanese version of the Montreal Cognitive Assessment: A pilot study

PurposePrior studies have indicated that patients with chronic obstructive pulmonary disease (COPD) exhibit significant cognitive defects on neuropsychological testing. Obstructive sleep apnea (OSA) is common in patients with COPD and is associated with reduced cognitive function; however, the combined impact of these two conditions on cognitive function is unknown. The aim of the study was to investigate the impact of OSA on cognitive impairment in patients with COPD.MethodsSixty-five stable COPD patients aged over 60 years underwent overnight polysomnography (PSG). Global cognitive functions were evaluated using the Mini-Mental State Examination (MMSE).ResultsCompared to patients with COPD alone, patients with both COPD and OSA performed worse on the MMSE (25.5±2.9 vs 23.5±3.2; p=0.01) and were more likely to be at risk for developing dementia based on the MMSE score (MMSE≤24) (31% vs 66%; p<0.01), independent of key demographic, educational and medical variables known to affect cognitive function in COPD. COPD patients with an apnea hypopnea index (AHI) of ≥30 events/h had lower MMSE scores than those with an AHI of <15 events/h. In addition to age and education level, the severity of nocturnal intermittent hypoxia is an independent predictor of the risk of dementia in patients with COPD (OR=1.24, 95% CI 1.04–1.48, p = 0.02).ConclusionThe current findings indicate that patients with COPD with comorbid OSA may be at greater risk for global cognitive impairment relative to patients with COPD alone. The mechanisms underlying the exaggerated cognitive dysfunction seem to be related to intermittent hypoxia. Further work is needed to understand the impact of OSA on the specific domains of cognitive impairment and the therapeutic implications of OSA in COPD.

Cognitive impairment is prevalent in Chinese patients with hypertension; however, current evidence on prevalence and risk factors is required to be synthesized. This systematic review and meta-analysis aimed to evaluate the prevalence and risk factors of cognitive impairment in Chinese patients with hypertension. Two reviewers independently searched PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, the Wanfang database, and the VIP database from their inception to 7 June 2023. The gray literature and the reference lists of the included studies were also retrieved manually. Moreover, we also independently performed the eligibility screening, data extraction, and data synthesis. The primary outcome was the prevalence of cognitive impairment in Chinese patients with hypertension, and the secondary outcomes were the risk factors for cognitive impairment in patients with hypertension. R (version 4.0.3) was used for data synthesis. In total, 82 studies involving 53,623 patients with hypertension were included in this meta-analysis. The pooled prevalence of cognitive impairment in patients with hypertension was 37.6% (95% CI: 33.2-42.2%). A total of 12 risk factors, including advanced age (r = -0.34, 95% CI: -0.45, -0.21), female sex (OR = 1.15, 95% CI: 1.01-1.32), BMI > 24 Kg/m2 (OR = 1.76, 95% CI: 1.04-3.00), lower educational level (OR = 2.01, 95% CI: 1.10-3.67), single status (OR = 1.63, 95% CI: 1.32-2.02), complications with diabetes (OR = 1.44, 95% CI: 1.14-1.80), coronary heart disease (OR = 1.49, 95% CI: 1.12-1.97), higher stage of hypertension [stage 3 vs. stage 1, OR = 3.08, 95% CI: 1.82-5.22; stage 2 vs. stage 1, OR = 1.83, 95% CI: 1.29-2.60], no regular physical activity (OR = 0.40, 95% CI: 0.21-0.77), higher levels of systolic blood pressure (r = -0.25, 95% CI: -0.42, -0.08), Hcy (r = -0.39, 95% CI: -0.63, -0.09), and IL-6 (r = -0.26, 95% CI: -0.48, -0.02) were detected. Cognitive impairment is prevalent in Chinese patients with hypertension, and the increased prevalence was associated with several demographic characteristics, complicated disease, no regular physical activity, worse hypertension status (higher stages and SBP), and high levels of biomarkers. Therefore, more attention should be paid to the early identification and treatment of patients with hypertension who are at high risk for cognitive impairment in clinical practice. In addition, relevant risk factors should be controlled to reduce the incidence of cognitive impairment. http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42023410437].

Background &amp; Objective: The objective of this study was to explore the risk factors for cognitive impairment in patients with cerebral small vessel disease (CSVD), and to construct a predictive model for cognitive impairment in CSVD patients, providing personalized diagnostic and treatment strategies for patients. Methods: Clinical data and blood indicators of CSVD patients admitted to the Department of Neurology at the Second Affiliated Hospital of Shandong First Medical University from February 2022 to February 2023 were collected. Additionally, these patients underwent cranial MRI examinations and completed neurological and psychological assessments, including the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE). Based on the MoCA and MMSE results, the patients were divided into the cognitive impairment group and the normal cognitive group. Clinical data, blood indicators, and white matter lesion (WML) grades were compared between the two groups. Univariate logistic regression analysis was performed to identify the risk factors for cognitive impairment in CSVD patients. Using MoCA assessment results as the gold standard and several clinical indicators as independent variables, a logistic regression model was constructed. Predicted values were calculated based on this model, and a receiver operating characteristic (ROC) curve for the comprehensive diagnosis of multiple variables was plotted to evaluate the model’s accuracy. Results: A total of 134 CSVD patients were included, and cognitive impairment occurred in 98 cases, with an incidence rate of 73.13%, while 36 patients did not have cognitive impairment. Univariate logistic regression analysis of the collected variables identified eight factors: age, education level, hypertension, diabetes, cerebral hemorrhage, low-density lipoprotein cholesterol (LDL-C), hyperhomocysteine (HHCY), and WML grading. Multivariate logistic regression analysis identified age, LDL-C, and WML grading as the final predictive factors, establishing a combined diagnostic model to predict the probability of cognitive impairment in patients. The constructed ROC curve for the comprehensive diagnosis of multiple variables yielded an area under the curve of 0.870, indicating good accuracy. To facilitate clinical diagnosis, the combined diagnostic model was simplified into an L score calculation formula, with the optimal cutoff value of 5.223. When the L score is &lt;5.223, the patient can be considered not having cognitive impairment, while an L score &gt;5.223 indicates cognitive impairment, allowing for the prediction of the risk of cognitive impairment in patients. Conclusion: Age, education level, hypertension, diabetes, cerebral hemorrhage, LDL-C, HHCY, and WML grading are related risk factors for cognitive impairment in CSVD patients. Age, LDL-C, and WML grading are independent risk factors for cognitive impairment in CSVD patients. The clinical predictive model for cognitive impairment in cerebral small vessel disease, constructed using the final predictive factors, showed good performance and clinical utility. It facilitates individualized risk assessment for cognitive impairment in CSVD patients and allows for targeted follow-up observation for high-risk individuals.