O7.12 Cognitive Impairment

Cognitive dysfunction has been described in people with COPD as in other chronic diseases such as cardiac failure and diabetes. The frequency of cognitive dysfunction varies depending upon the battery of neuropsychological tests used, with the domains most influenced being memory and attention. In a population cohort of community dwelling elderly (age 70-89) with normal cognition, those who had a diagnosis of COPD at baseline (based on medical record data), had an 83% increased risk of incident non-amnesic mild cognitive impairment (hazard ratio 1.83, 95% CI 1.04-3.23) over 5 years (Singh 2014a). Cognitive function in patients admitted to hospital with an exacerbation of COPD was more impaired than in patients with stable COPD which in turn was worse than in a matched control group (Dodd 2013) [evidence level III-2].

In a meta-analysis of 655 patients with stable COPD and 394 control participants, cognitive function was associated with severity of COPD only in those with severe to very severe disease (Schou 2012).  Baird et al performed a systemic review of 13 studies of the effect of cognitive impairment on self-management in COPD and demonstrated high degrees of inhaler incompetency with cognitive impairment, although dry powder inhalers are easier to learn to use (Baird 2017).  As memory and attention, as well as speed, co-ordination and learning ability were shown to be reduced, it may be important to consider level of cognitive impairment when assessing capacity for self-management.

Potential aggregate anticholinergic effects of concurrent oral and inhaled medications should be considered in patients with cognitive impairment.