There is an open access paper ‘COPD and cognitive impairment: The role of hypoxaemia and oxygen therapy’ by Thakur and colleagues available here. The researchers examined the relationship between COPD and cognitive impairment by correlating MMSE scores and COPD severity in a cohort of 1202 subjects and comparing them with 302 healthy controls. Demographic data was also collected and COPD severity was measured using an aggregate of 5 markers of COPD severity. Multivariate logistic regression analysis was used to assess the relationship between COPD severity and cognitive impairment controlling for other variables (e.g demographic). The control group were closely matched on most variables except smoking (more in the control group were current smokers) and there were more people with college/graduate degrees in the control group also. Cognitive impairment was defined as an MMSE score of less than 24. The researchers found a significant association between MMSE < 24 and low oxygen saturation (<88%)(lower limit of confidence interval is just over 1) an inverse association with home oxygen association and interestingly no relationship with COPD severity. The researchers note in their conclusion that the MMSE is not a useful tool for detection of mild cognitive impairment and suggest more detailed neuropsychological testing. However it would be interesting to repeat the cognitive testing in order to identify the direction of the relationship as cognitive impairment can impact on management. Also this would be useful in identifying acute changes in cognition and it would be useful to categorise the cognitive impairment (i.e delirium, MCI, dementia). I thought the oxygen saturation results although expected were useful.
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