Abstract
The neural correlates of cognitive impairment in chronic obstructive pulmonary disease (COPD) are not yet understood. Structural brain abnormalities could possibly be associated with the presence of cognitive impairment through cigarette smoke, inflammation, vascular disease, or hypoxemia in these patients. This study aimed to investigate whether macrostructural brain magnetic resonance imaging (MRI) features of cerebral small vessel disease (SVD) and hippocampal volume (HCV) are related to cognitive performance in patients with COPD. A subgroup of cognitively high and low-performing COPD patients of the COgnitive-PD study, underwent a brain 3T MRI. SVD as a marker of vascular damage was assessed using qualitative visual rating scales. HCV as a marker of neurodegeneration was assessed using the learning embedding for atlas propagation (LEAP) method. Features of SVD and HCV were compared between cognitively high and low-performing individuals using Mann Whitney U tests and independent samples t-tests, respectively. No group differences were reported between 25 high-performing (mean age 60.3 (standard deviation [SD] 9.7) years; 40.0% men; forced expiratory volume in first second [FEV1] 50.1% predicted) and 30 low-performing patients with COPD (mean age 60.6 (SD 6.8) years; 53.3% men; FEV1 55.6% predicted) regarding demographics, clinical characteristics, comorbidities and the presence of the SVD features and HCV. To conclude, the current study does not provide evidence for a relationship between cerebral SVD and HCV and cognitive functioning in patients with COPD. Additional studies will be needed to determine other possible mechanisms of cognitive impairment in patients with COPD, including microstructural brain changes and inflammatory-, hormonal-, metabolic- and (epi)genetic factors.
Highlights
MATERIALS AND METHODSChronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease which is primarily characterized by progressive airflow limitation (Vestbo et al, 2013)
In order to verify whether small vessel disease (SVD) and hippocampal volume (HCV) may explain the level of cognitive functioning in patients with chronic obstructive pulmonary disease (COPD), this study aimed to assess whether and to what extent SVD and HCV differ between COPD patients with high and low cognitive performance
Categorical variables are described as frequencies, while continuous variables were tested for normality and are presented as mean and standard deviation (SD) or median and interquartile range (IQR)
Summary
MATERIALS AND METHODSChronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease which is primarily characterized by progressive airflow limitation (Vestbo et al, 2013). Patients with COPD often suffer from a variety of comorbid and biological conditions (Divo et al, 2012; Vanfleteren et al, 2013). These biological changes may have adverse effects on the brain leading to cognitive impairment. Structural brain abnormalities are considered an important cause of cognitive impairment, especially decreased hippocampal volume (HCV), which has been associated with decreased memory (Soininen et al, 1994; Schuff et al, 2009; Wolz et al, 2010b), and features of cerebral small vessel disease (SVD; Cai et al, 2015). The main risk factors for SVD are increased age and hypertension
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