COPD 患者因加重而住院的比因心力衰竭失代偿而住院的患者认知障碍更严重。
COPD patients hospitalized with exacerbations have greater cognitive impairment than patients hospitalized with decompensated heart failure.
机构信息
Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
Clinical Pharmacology, Institute of Infection and Immunity, St George's University of London, London, UK,
出版信息
Clin Interv Aging. 2018 Dec 18;14:1-8. doi: 10.2147/CIA.S185981. eCollection 2019.
PURPOSE
People with COPD have cognitive dysfunction, which is greater in those hospitalized for exacerbations than in stable outpatients. We tested the hypothesis that cognitive dysfunction at exacerbation is a disease-specific feature of COPD, rather than a nonspecific feature of hospitalization for acute illness, by comparing cognition between patients hospitalized for acute COPD exacerbations and those with worsening heart failure (HF).
PATIENTS AND METHODS
A total of 40 hospital inpatients were recruited, 20 patients with COPD exacerbations and 20 patients with congestive or left-sided HF. Exclusion criteria included previous stroke, known neurological disease, and marked alcohol excess. Participants completed the Montreal cognitive assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) and underwent spirometry and review of clinical records.
RESULTS
Age (mean±SD, COPD 73±10; HF 76±11 years), acute illness severity (Acute Physiology and Chronic Health Evaluation [APACHE]-II, COPD 15.4±3.5; HF 15.9±3.0), comorbidities (Charlson index, COPD 1.3±1.9; HF 1.6±1.5), and educational background were similar between COPD and HF groups. MoCA total was significantly lower in COPD than in HF (COPD 20.6±5.6; HF 24.8±3.5, =0.007); however, significance was lost after correction for age, sex, and pack year smoking history. When compared with HF patients, the COPD cohort performed worse on the following domains of the MoCA: visuospatial function (median [IQR], COPD 0 [1]; HF 2 [1], =0.003), executive function (COPD 2 [1]; HF 3 [1], =0.035), and attention (COPD 4 [3]; HF 6 [2], =0.020). Age (=0.012) and random glucose concentration (=0.041) were associated with cognitive function in whole group analysis, with pack year smoking history reaching borderline significance (=0.050).
CONCLUSION
Total MoCA score for COPD and HF indicated that both groups had mild cognitive impairment, although this was greater in people with COPD. Mechanisms underlying the observed cognitive dysfunction in COPD remain unclear but appear related to blood glucose concentrations and greater lifetime smoking load.
目的
慢性阻塞性肺疾病（COPD）患者存在认知功能障碍，在因加重而住院的患者中比稳定期门诊患者更为严重。我们通过比较因 COPD 加重而住院的患者和心力衰竭（HF）恶化的患者之间的认知功能，检验了认知功能障碍在加重期是 COPD 的特异性特征，而不是因急性疾病住院的非特异性特征的假说。
方法
共招募了 40 名住院患者，其中 20 名 COPD 加重患者和 20 名充血性或左侧 HF 患者。排除标准包括既往卒中、已知神经疾病和明显的酒精过量。参与者完成了蒙特利尔认知评估（MoCA）和医院焦虑和抑郁量表（HADS），并进行了肺功能检查和临床记录审查。
结果
年龄（平均值±标准差，COPD 73±10；HF 76±11 岁）、急性疾病严重程度（急性生理学和慢性健康评估 [APACHE]-II，COPD 15.4±3.5；HF 15.9±3.0）、合并症（Charlson 指数，COPD 1.3±1.9；HF 1.6±1.5）和教育背景在 COPD 和 HF 组之间相似。COPD 的 MoCA 总分明显低于 HF（COPD 20.6±5.6；HF 24.8±3.5，=0.007）；然而，在校正年龄、性别和吸烟包年数后，差异无统计学意义。与 HF 患者相比，COPD 组在 MoCA 的以下领域表现更差：视觉空间功能（中位数[IQR]，COPD 0[1]；HF 2[1]，=0.003）、执行功能（COPD 2[1]；HF 3[1]，=0.035）和注意力（COPD 4[3]；HF 6[2]，=0.020）。在全组分析中，年龄（=0.012）和随机血糖浓度（=0.041）与认知功能相关，吸烟包年数接近显著性水平（=0.050）。
结论
COPD 和 HF 的 MoCA 总分表明，两组患者均有轻度认知障碍，尽管 COPD 患者的认知障碍更为严重。COPD 中观察到的认知功能障碍的机制尚不清楚，但似乎与血糖浓度和更大的终生吸烟负荷有关。
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