Siraj R A, McKeever T M, Gibson J E, Gordon A L, Bolton C E
NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.
Respir Med. 2021 Feb;177:106288. doi: 10.1016/j.rmed.2020.106288. Epub 2020 Dec 24.
Although cognitive impairment and dementia are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), estimates of incidence following a diagnosis of COPD are inconclusive.
To determine the incidence of cognitive impairment and dementia in people with and without a COPD diagnosis.
A population-based study using UK General Practice (GP) health records from The Health Improvement Network database was conducted. Patients with confirmed COPD diagnosis, ≥40 years old, were matched to up to four subjects without a COPD diagnosis by age, sex and GP practice. Cox proportional hazards models were used to assess the incidence rates of cognitive impairment and dementia.
Of patients with COPD (n = 62,148), 9% developed cognitive impairment, compared with 7% of subjects without COPD (n = 230,076), p < 0.001. The incidence of cognitive impairment following COPD diagnosis was greater than in subjects without COPD following index date (adjusted Hazard Ratio (aHR), 1.21; 95% CI: 1.16 ─ 1.26, p < 0.001). The coded incidence of either cognitive impairment or dementia was also greater in patients with COPD following adjustment for confounders (aHR: 1.13, 95% CI: 1.09 ─ 1.18, p < 0.001). Coded incident dementia alone was not different between patients with COPD and subjects without COPD (aHR, 0.91, 95% CI: 0.83 ─ 1.01, p = 0.053).
Despite the increased incidence of cognitive impairment in patients with COPD, incidence of dementia was not as frequently recorded in patients with COPD. This raises the concern of undiagnosed dementia and emphasises the need for a systematic assessment in this population.
尽管认知障碍和痴呆是慢性阻塞性肺疾病（COPD）患者常见的合并症，但COPD诊断后的发病率估计尚无定论。
确定有和没有COPD诊断的人群中认知障碍和痴呆的发病率。
利用来自健康改善网络数据库的英国全科医疗（GP）健康记录进行了一项基于人群的研究。确诊为COPD且年龄≥40岁的患者，按年龄、性别和全科医疗诊所与最多4名无COPD诊断的受试者进行匹配。采用Cox比例风险模型评估认知障碍和痴呆的发病率。
COPD患者（n = 62148）中有9%发生认知障碍，而无COPD的受试者（n = 230076）中这一比例为7%，p < 0.001。COPD诊断后认知障碍的发病率高于索引日期后无COPD的受试者（调整后风险比（aHR），1.21；95%置信区间：1.16 ─ 1.26，p < 0.001）。在对混杂因素进行调整后，COPD患者中认知障碍或痴呆的编码发病率也更高（aHR：1.13，95%置信区间：1.09 ─ 1.18，p < 0.001）。仅编码的新发痴呆在COPD患者和无COPD的受试者之间没有差异（aHR，0.91，95%置信区间：0.83 ─ 1.01，p = 0.053）。
尽管COPD患者认知障碍的发病率有所增加，但COPD患者中痴呆的发病率记录并不那么频繁。这引发了对未诊断痴呆的担忧，并强调了对该人群进行系统评估的必要性。
