Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand.
Respiratory Department, Hutt Valley District Health Board, Lower Hutt, New Zealand.
Intern Med J. 2019 Oct;49(10):1307-1312. doi: 10.1111/imj.14259.
The reported prevalence of cognitive impairment in patients with stable chronic obstructive pulmonary disease (COPD) ranges 36-77%. Few studies report the prevalence of cognitive impairment in acutely unwell COPD patients.
To determine the prevalence and time course of cognitive impairment in patients with COPD during and after an admission to hospital with an exacerbation of the disease.
Patients admitted to hospital with an exacerbation of COPD between October 2013 and November 2014 were administered the Montreal Cognitive Assessment tool, COPD assessment test and modified Borg dyspnoea scale at three points in time: within 24 h of admission, between 48 and 72 h after admission and 6 weeks post discharge.
Twenty-five patients agreed to participate. Four withdrew from the study after the initial evaluation. The mean (range) COPD assessment test score 24 h after admission was 26 (18-37). Cognitive impairment was found in 19/25 (76%) patients at the initial evaluation, 16/21 (76%) patients at the second evaluation. Overall, 22/25 (88%) showed cognitive impairment within 72 h of an exacerbation of COPD. Fourteen out of 21 (66%) patients showed cognitive impairment at the final evaluation. The mean Montreal Cognitive Assessment scores improved from admission (22.6) to the second evaluation (23.3) to the final evaluation 3 (24.4), but this change was not statistically significant.
Cognitive impairment is highly prevalent during hospital admissions with an exacerbation of COPD. This impairment does improve with time, but only a minority recover within a normal range. This will affect patients' abilities to understand and remember information given to them in hospital and adhere to medication regimens.
稳定期慢性阻塞性肺疾病（COPD）患者认知障碍的报告患病率为 36-77%。很少有研究报告急性加重期 COPD 患者认知障碍的患病率。
确定 COPD 患者在因疾病加重而住院期间和出院后认知障碍的患病率及其时间进程。
2013 年 10 月至 2014 年 11 月期间因 COPD 加重而住院的患者在三个时间点接受蒙特利尔认知评估工具、COPD 评估测试和改良 Borg 呼吸困难量表评估：入院后 24 小时内、入院后 48-72 小时和出院后 6 周。
25 名患者同意参与。4 名患者在初始评估后退出研究。入院后 24 小时 COPD 评估测试评分的平均值（范围）为 26（18-37）。在初始评估时，19/25（76%）名患者存在认知障碍，16/21（76%）名患者在第二次评估时存在认知障碍。总体而言，22/25（88%）名患者在 COPD 加重后 72 小时内出现认知障碍。21 名患者中的 14 名（66%）在最终评估时存在认知障碍。蒙特利尔认知评估评分从入院时的 22.6 提高到第二次评估时的 23.3，再到最终评估时的 24.4，但这一变化无统计学意义。
COPD 加重住院期间认知障碍的患病率很高。这种损伤随着时间的推移而改善，但只有少数患者能恢复到正常范围。这将影响患者在医院中理解和记住所给信息以及遵守药物治疗方案的能力。
