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 subjects, cognitive function was associated with severity of COPD only in those with severe to very severe disease (Schou 2012). It is unclear how detected deficits in cognitive function relate to clinical disability in performing self-management and self-care, nor is it clear which tests are most appropriate for assessing cognitive dysfunction in these patients. 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, although this has not been clearly demonstrated.

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