重度慢性阻塞性肺疾病(COPD)伴或不伴长期氧疗(LTOT)的认知功能障碍

IF 2.3 Multidisciplinary Respiratory Medicine Pub Date : 2015-04-19 eCollection Date: 2015-01-01 DOI:10.1186/s40248-015-0013-4
Roberto W Dal Negro, Luca Bonadiman, Fernanda P Bricolo, Silvia Tognella, Paola Turco
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引用次数: 30

摘要

背景:慢性阻塞性肺疾病(COPD)是一种进行性呼吸系统疾病,可导致不同严重程度的合并症,包括认知功能障碍。补充氧气在预防copd引起的认知退化中的作用仍然存在争议,但只是偶尔调查。本研究的目的是比较低氧血症COPD患者接受长期供氧(LTOT)治疗的认知模式与不定期供氧的同等严重程度患者的认知模式以及正常参考值。方法:肺功能、动脉血气、健康状况和认知功能通过四种不同认知领域的心理测试(如:MMSE、Clock测试;TMT-A;在146例匹配良好的低氧血症COPD患者中评估TMT-B(男性n = 96, 66%;平均年龄= 70.5±12.9)。73例患者采用长期供氧(LTOT),其余73例仅按需供氧(AN)。统计学方面采用t检验和ANOVA (Duncan检验)对数据进行分析,以p < 0.05为最低显著性限。结果:尽管所有COPD患者的心理测量值都低于相应的正常参考值,但LTOT患者的认知能力严重恶化的发生率较低。TMT-A和TMT-B评估时,这些患者的损伤程度也显著降低(p分别< 0.012和0.001),但MMSE和Clock测试时则没有这种情况(p均= ns)。慢性阻塞性肺病患者持续低氧血症对几个认知领域的影响是不同的。需要一组心理测量工具来识别这些患者的认知功能障碍模式。记忆和注意力(MMSE和Clock测试评估的功能)仅受到轻度至中度影响,而视觉加工、数字序列再现、认知灵活性和移动能力(TMT-A和TMT-B评估的功能)则受到更严重的影响(p < 0.012和p < 0.001)。结论:只有LTOT能显著保护copd引起的认知功能恶化(p < 0.022)。这一假设对于长期吸氧的慢性阻塞性肺病患者具有战略价值,因为他们经常没有意识到与他们的病情相关的认知风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Cognitive dysfunction in severe chronic obstructive pulmonary disease (COPD) with or without Long-Term Oxygen Therapy (LTOT).

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition which can lead to comorbidities of variable severity, cognitive dysfunction included. The role of supplemental oxygen in preventing COPD-induced cognitive deterioration is still debated, but only episodically investigated. The aim of this study was to compare the cognitive pattern of hypoxemic COPD subjects treated with long-term oxygen (LTOT) to that of patients of comparable severity assuming oxygen on irregular basis, and to normal reference values.

Methods: Lung function, arterial blood gases, health status, and cognitive function measured by means of four psychometric tests focusing different domains of cognition (such as: MMSE, Clock test; TMT-A; TMT-B) were assessed in 146 well matched hypoxemic COPD patients (males n = 96, 66%; mean age = 70.5 ± 12.9). Seventy-three patients were assuming long-term oxygen (LTOT), while the remaining seventy-three were only using oxygen as needed (AN). Regarding statistics, t test and ANOVA (Duncan test) were used to analyze data, assuming a p < 0.05 as the lowest limit of significance.

Results: Even though all COPD patients showed a poorer psychometric profile vs corresponding normal reference values, LTOT patients showed a lower prevalence of severe deterioration in cognition. Also the extent of impairment was significantly lower in these patients when assessed by TMT-A and TMT-B (p < 0.012 and 0.001, respectively), but not when measured by MMSE and Clock test (both p = ns). Several domains of cognition are variably affected by persistent hypoxemia in COPD patients. A panel of psychometric tools is needed for identifying the pattern of cognitive dysfunctions in these patients. Memory and attention (functions assessed by MMSE and Clock test) are only mildly-moderately affected, while visual processing, reproduction of numeric sequences, cognition flexibility, and shifting capacity (functions assessed by TMT-A and TMT-B) are much more deteriorated (p < 0.012 and p < 0.001, respectively).

Conclusions: Only LTOT allows to preserve significantly (p < 0.022) cognitive functions from the COPD-induced deterioration. This assumption is of strategic value for COPD patients who are prescribed long-term oxygen because they frequently are not aware of the cognitive risks related to their condition.

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Multidisciplinary Respiratory Medicine
Multidisciplinary Respiratory Medicine Medicine-Pulmonary and Respiratory Medicine
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期刊介绍: Multidisciplinary Respiratory Medicine is the official journal of the Italian Respiratory Society - Società Italiana di Pneumologia (IRS/SIP). The journal publishes on all aspects of respiratory medicine and related fields, with a particular focus on interdisciplinary and translational research. The interdisciplinary nature of the journal provides a unique opportunity for researchers, clinicians and healthcare professionals across specialties to collaborate and exchange information. The journal provides a high visibility platform for the publication and dissemination of top quality original scientific articles, reviews and important position papers documenting clinical and experimental advances.
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