Background

Although cognitive impairment and dementia are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), estimates of incidence following a diagnosis of COPD are inconclusive.

Objective

To determine the incidence of cognitive impairment and dementia in people with and without a COPD diagnosis.

Methods

A population-based study using UK General Practice (GP) health records from The Health Improvement Network database was conducted. Patients with confirmed COPD diagnosis, ≥40 years old, were matched to up to four subjects without a COPD diagnosis by age, sex and GP practice. Cox proportional hazards models were used to assess the incidence rates of cognitive impairment and dementia.

Results

Of patients with COPD (n = 62,148), 9% developed cognitive impairment, compared with 7% of subjects without COPD (n = 230,076), p < 0.001. The incidence of cognitive impairment following COPD diagnosis was greater than in subjects without COPD following index date (adjusted Hazard Ratio (aHR), 1.21; 95% CI: 1.16 ─ 1.26, p < 0.001). The coded incidence of either cognitive impairment or dementia was also greater in patients with COPD following adjustment for confounders (aHR: 1.13, 95% CI: 1.09 ─ 1.18, p < 0.001). Coded incident dementia alone was not different between patients with COPD and subjects without COPD (aHR, 0.91, 95% CI: 0.83 ─ 1.01, p = 0.053).

Conclusion

Despite the increased incidence of cognitive impairment in patients with COPD, incidence of dementia was not as frequently recorded in patients with COPD. This raises the concern of undiagnosed dementia and emphasises the need for a systematic assessment in this population.

中文翻译：

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慢性阻塞性肺疾病 (COPD) 患者发生痴呆和认知障碍的风险：一项基于英国人口的大型研究

背景

尽管认知障碍和痴呆是慢性阻塞性肺病 (COPD) 患者常见的合并症，但诊断 COPD 后的发病率估计尚无定论。

客观的

确定患有或未患有慢性阻塞性肺病（COPD）诊断的人群中认知障碍和痴呆的发生率。

方法

使用健康改善网络数据库中的英国全科医生 (GP) 健康记录进行了一项基于人群的研究。已确诊 COPD 诊断（年龄≥40 岁）的患者根据年龄、性别和全科医生实践与最多四名未诊断为 COPD 的受试者进行匹配。Cox比例风险模型用于评估认知障碍和痴呆的发生率。

结果

在 COPD 患者 (n = 62,148) 中，9% 出现认知障碍，而无 COPD 受试者 (n = 230,076) 的这一比例为 7%，p < 0.001。COPD 诊断后认知障碍的发生率高于索引日期后无 COPD 的受试者（调整后风险比 (aHR)，1.21；95% CI：1.16 ─ 1.26，p < 0.001）。调整混杂因素后，COPD 患者认知障碍或痴呆的编码发生率也较高（aHR：1.13，95% CI：1.09 ─ 1.18，p < 0.001）。COPD 患者和非 COPD 受试者之间单独编码的痴呆事件没有差异（aHR，0.91，95% CI：0.83 ─ 1.01，p = 0.053）。

结论

尽管慢性阻塞性肺病患者认知障碍的发生率有所增加，但慢性阻塞性肺病患者痴呆的发生率并不高。这引起了对未确诊痴呆症的关注，并强调了对该人群进行系统评估的必要性。