Dr Singh: There are several tools easily available for screening for cognitive impairment, such as the Short Test of Mental Status (STMS), the Montreal Cognitive Assessment (MoCA), and the Mini-Mental State Examination (MMSE). These cognitive screens usually take approximately 5 to 10 minutes. For patients who screen positive on these tests, a comprehensive neuropsychological evaluation could be considered. In the treatment of COPD, an evaluation by a pulmonologist can be considered.

Pulmonology Advisor: What are other relevant recommendations for clinicians?

Dr Morris: COPD is a multisystem disorder with far-reaching consequences way beyond the lungs. The majority of cases — but not all — are caused by tobacco smoking. One takeaway from this, and indeed any other study about COPD, is the urgent importance of helping our patients stop smoking to reduce their risk of developing COPD or COPD-related cognitive impairment in the future.

Based on this study and the other published literature, I think there is good evidence that people with COPD are more likely to have cognitive impairment, and awareness of this is important for our patients. 

Dr Singh: Patients with COPD are at high risk for cognitive impairment, and reducing the risk factors and treating COPD effectively may help reduce that risk. The presence of COPD may serve as a risk marker for MCI and may facilitate targeted preventive or therapeutic interventions. There is a need for further research in this field.

Pulmonology Advisor: What are the remaining needs in terms of research or education regarding this topic?

Dr Morris: In my view, further research is needed to establish whether there is COPD-associated cognitive impairment affecting different cognitive domains and caused by a different pathologic process than other dementias such as Alzheimer disease, or whether people with COPD are simply more likely to develop vascular dementia or Alzheimer than the general population. 

Dr Singh: For research, the increased risk for MCI associated with COPD can be explored further using biomarkers, neuroimaging, and genetic linkage analysis.

From the patient education perspective, I think it is important for patients to be aware of the risk for cognitive impairment with COPD. Smoking cessation reduces the risk for COPD, especially early in treatment, and thus may help reduce the risk for MCI. Identifying risk factors for MCI, the earliest symptomatic phase of Alzheimer disease, may help to identify ways to delay or prevent the onset of dementia, especially in the absence of a curative therapy for Alzheimer disease.

References

  1. Chatila WM, Thomashow BM, Minai OA, Criner GJ, Make BJ. Comorbidities in chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2008;5(4):549-555.
  2. Morris C, Mitchell JW, Moorey H, Younan HC, Tadros G, Turner AM. Memory, attention and fluency deficits in COPD may be a specific form of cognitive impairment. ERJ Open Res. 2019;5(2):00229-2018.
  3. Singh B, Parsaik AK, Mielke MM, et al. Chronic obstructive pulmonary disease and association with mild cognitive impairment: the Mayo Clinic Study of Aging. Mayo Clin Proc. 2013;88(11):1222-1230.
  4. Singh B, Mielke MM, Parsaik AK, et al. A prospective study of chronic obstructive pulmonary disease and the risk for mild cognitive impairment. JAMA Neurol. 2014;71(5):581-588.