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Brain perfusion abnormalities in chronic obstructive pulmonary disease: comparison with cognitive impairment

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Abstract

Objectives

To clarify cerebral perfusion distribution and cognitive functions in patients with chronic obstructive pulmonary disease (COPD) according to the hypoxia levels and to assess if there is a relationship between cognitive impairment and cerebral perfusion index.

Patients and Methods

Eight patients with stable hypoxemic COPD (HC), 10 patients with stable nonhypoxemic COPD (NHC), and 10 age-matched healthy volunteers participated in the study. All subjects underwent a complete neuropsychological assessment with the mental deterioration battery (MDB), Wechsler memory scale-revised (WMS-R), color trail test (CCT), and grooved pegboard test (GPT). SPECT examination with Tc-99m HMPAO was performed in all patients and controls. Quantitative analysis was performed by a region of interest (ROI)-based method.

Results

The scores of verbal memory, delayed recall and attention were significantly lower in COPD patients (p < 0.01). The scores of other subtests were similar in patients and controls. Comparing NHC patients to HC groups showed that verbal memory was impaired in both groups, but delayed recall and attention scores were significantly worse in HC patients than NHC patients. Perfusion indexes on frontal ROIs in NHC patients and frontal and parietal ROIs in HC patients showed significant decreases. Our scintigraphic findings were correlated with the results of neuropsychological tests.

Conclusions

Our results demonstrate that cerebral perfusion is significantly altered in COPD patients. Hypoxemic patients showed more deterioration in cerebral perfusion and cognitive performance than nonhypoxemic patients. The relationship between decreased perfusion and cognitive impairment and the clinical significance of these results require further studies in larger populations.

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References

  1. Wouters EF, Creutzberg EC, Schols AM. Systemic effects in COPD.Chest 2002; 121:127–130.

    Article  Google Scholar 

  2. Engelen MP, Schols AM, Baken WC, Wesseling GJ, Wouters EF. Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD.Eur Respir J 1994; 7:1793–1797.

    Article  PubMed  CAS  Google Scholar 

  3. Engelen MP, Deutz NE, Wouters EF, Schols AM. Enhanced levels of whole-body protein turnover in patients with chronic obstructive pulmonary disease.Am J Respir Crit Care Med 2000; 162:1488–1492.

    PubMed  CAS  Google Scholar 

  4. Gross NJ. Extrapulmonary effects of chronic obstructive pulmonary disease.Curr Opin Pulm Med 2001; 7 (2):84–92.

    Article  PubMed  CAS  Google Scholar 

  5. Ambrosino N, Bruletti G, Scala V, Porta R, Vitacca M. Cognitive and perceived health status in patient with chronic obstructive pulmonary disease surviving acute on chronic respiratory failure: a controlled study.Intensive Care Med 2002; 28 (2):170–177.

    Article  PubMed  Google Scholar 

  6. Meek PM, Lareau SC, Anderson D. Memory for symptoms in COPD patients: how accurate are their reports?Eur Respir J 2001; 18(3):474–481.

    Article  PubMed  CAS  Google Scholar 

  7. Kozora E, Filley CM, Julian LJ, Cullum CM. Cognitive functioning in patients with chronic obstructive pulmonary disease and mild hypoxemia compared with patients with mild Alzheimer disease and normal controls.Neuropsy-chiatry Neuropsychol Behav Neurol 1999; 12(3):178–183.

    CAS  Google Scholar 

  8. Etnier J, Johnston R, Dagenbach D, Pollard RJ, Rejeski WJ, Berry M. The relationships among pulmonary function, aerobic fitness, and cognitive functioning in older COPD patients.Chest 1999; 116(4):953–960.

    Article  PubMed  CAS  Google Scholar 

  9. Prigatano GP, Parsons O, Wright E, Levin DC, Hawryluk G. Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease.J Consult Clin Psychol1983; 51(1):108–116.

    Article  PubMed  CAS  Google Scholar 

  10. Fix AJ, Golden CJ, Daughton D, Kass I, Bell CW. Neuro-psychological deficits among patients with chronic obstructive pulmonary disease.Int J Neurosci 1982; 16(2):99–105.

    Article  PubMed  CAS  Google Scholar 

  11. Grant I, Heaton RK, McSweeny AJ, Adams KM, Timms RM. Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease.Arch Intern Med 1982; 142(8):1470–1476.

    Article  PubMed  CAS  Google Scholar 

  12. Antonelli Incalzi R, Chiappini F, Fuso L, Torrice MP, Gemma A, Pistelli R. Predicting cognitive decline in patients with hypoxaemic COPD.Respir Med 1998; 92(3):527–533.

    Article  Google Scholar 

  13. Stuss DT, Peterkin I, Guzman DA, Guzman C, Troyer AK. Chronic obstructive pulmonary disease: effects of hypoxia on neurological and neuropsychological measures.J Clin Exp Neuropsychol 1997; 19(4):515–524.

    Article  PubMed  CAS  Google Scholar 

  14. Antanoelli Incalzi R, Gemma A, Marra C, Muzzolon R, Capparella O, Carbonin P. Chronic obstructive pulmonary disease. An original model of cognitive decline.Am Rev Respir Dis 1993; 148(2):418–424.

    Google Scholar 

  15. Dustman RE, Emmerson R, Shearer D. Physical activity, age, and cognitive neuropsychological function.J Aging Phys Act 1994; 2:143–181.

    Google Scholar 

  16. Hansen P. Pathophysiology of chronic diseases and exercise training. Durstine JL ed.Resource manual for guidelines for exercise testing and prescription 2nd ed., Philadelphia, PA; Lea & Febiger, 1993: 187–197.

    Google Scholar 

  17. Marchai G, Rioux P, Petit-Taboue MC. Regional cerebral oxygen consumption, blood flow, and blood volume in healthy human aging.Arch Neurol 1992; 49:1013–1020.

    Google Scholar 

  18. Delia Sala S, Donner CF, Sacco C, Spinnler H. Does chronic lung failure lead to cognitive failure?Schweiz Arch Neurol Psychiatr 1992; 143:343–354.

    Google Scholar 

  19. Crews WD, Jefferson AL, Bolduc T, Elliott JB, Ferro NM, Broshek DK, et al. Neuropsychological dysfunction in patients suffering from end-stage chronic obstructive pulmonary disease.Arch Clin Neuropsychol 2001; 16(7):643–652.

    Article  PubMed  CAS  Google Scholar 

  20. Fioravanti M, Nacca D, Amati S, Buckley AE, Bisetti A. Chronic obstructive pulmonary disease and associated patterns of memory decline.Dementia 1995; 6(1):39–48.

    Article  PubMed  CAS  Google Scholar 

  21. Huppert FA. Memory impairment associated with chronic hypoxia.Thorax 1982; 37(11):858–860.

    Article  PubMed  CAS  Google Scholar 

  22. Mulloy E, McNicholas WT. Ventilation and gas exchange during sleep and exercise in severe COPD.Chest 1996; 109:387–394.

    Article  PubMed  CAS  Google Scholar 

  23. Grant I, Prigatano GP, Heaton RK, McSweeny AJ, Wright EC, Adams KM. Progressive neuropsychologic impairment and hypoxemia: relationship in chronic obstructive pulmonary disease.Arch Gen Psychiatr 1987; 44(11):999–1006.

    PubMed  CAS  Google Scholar 

  24. Mathur R, Cox IJ, Oatridge A, Shephard DT, Shaw RJ, Taylor-Robinson SD. Cerebral bioenergetics in stable chronic obstructive pulmonary disease.Am J Respir Crit Care Med 1999; 160(6):1994–1999.

    PubMed  CAS  Google Scholar 

  25. Hamilton G, Mathur R, Allsop JM, Forton DM, Dhanjal NS, Shaw RJ, et al. Changes in brain intracellular pH and membrane phospholipids on oxygen therapy in hypoxic patients with chronic obstructive pulmonary disease.Metab Brain Dis 2003; 18(1):95–109.

    Article  PubMed  CAS  Google Scholar 

  26. Shim TS, Lee JH, Kim SY, Lim TH, Kim SJ, Kim DS, et al. Cerebral metabolic abnormalities in COPD patients detected by localized proton magnetic resonance spectroscopy.Chest 2001; 120(5):1506–1513.

    Article  PubMed  CAS  Google Scholar 

  27. Incalzi RA, Marra C, Giordano A, Calcagni ML, Cappa A, Basso S, et al. Cognitive impairment in chronic obstructive pulmonary disease. A neuropsychological and SPECT study.J Neurol 2003; 250:325–332.

    Article  Google Scholar 

  28. American Thoracic Society. Standardization of spirometry, 1994 update.Am J Respir Crit Care Med 1995; 152:1107–1135.

    Google Scholar 

  29. Kennelly KJ, Hayslip B, Richardson SK. Depression and helplessness-induced cognitive deficits in the aged.Exp Aging Res 1985; 11(3-4):169–173.

    PubMed  CAS  Google Scholar 

  30. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, fourth ed. Washington; American Psychiatric Editors, 1994.

    Google Scholar 

  31. Wechsler D.Wechsler Adult Intelligence Scale—Revised Manual. San Antonio, TX; Psychological Corp., 1981.

    Google Scholar 

  32. Maj M, D’Elia L, Satz P, Janssen R, Zaudig M, Uchiyama C, et al. World Health Organization, Division of Mental Health/Global Programme on AIDS, Evaluation of two new neuropsychological tests designed to minimize cultural bias in the assessment of HIV-1 seropositive persons: a WHO study.Arch Clin Neuropsychol 1993; 8(2):123–135.

    Article  PubMed  CAS  Google Scholar 

  33. Mitrushin MN, Boone KB, D’Elia LF.Handbook of normative data for neuropsychological assessment. New York, NY; Oxford University Press, 1999: 428–447.

    Google Scholar 

  34. Tran Dinh YR, Mamo H, Cervoni J, Caulin C, Saimot AC. Disturbances in the cerebral perfusion of human immune deficiency virus-1 seropositive asymptomatic subjects: a quantitative tomography study of 18 cases.J Nucl Med 1990; 31:1601–1607.

    Google Scholar 

  35. Stulbarg MS, Carrieri-Kohlman V, Gormley JM, Tsang A, Paul S. Accuracy of recall of dyspnea after exercise training sessions.J Cardiopulm Rehabil 1999; 19(4):242–248.

    Article  PubMed  CAS  Google Scholar 

  36. Isoaho R, Puolijoki H, Huhti E, Laippala P, Kivela SL. Chronic obstructive pulmonary disease and cognitive impairment in the elderly.Int Psychogeriatr 1996; 8(1):113–125.

    Article  PubMed  CAS  Google Scholar 

  37. Lisansky DP, Clough DH. A cognitive-behavioral self-help educational program for patients with COPD. A pilot study.Psychother Psychosom 1996; 65(2):97–101.

    Article  PubMed  CAS  Google Scholar 

  38. Incalzi RA, Gemma A, Marra C, Capparella O, Fuso L, Carbonin P. Verbal memory impairment in COPD. Its mechanisms and clinical relevance.Chest 1997; 112(6):1506–1513.

    Article  PubMed  CAS  Google Scholar 

  39. Huang C, Wahlund LO, Almkvist O, Elehu D, Svensson L, Jonsson T, et al. Voxel- and VOI-based analysis of SPECT CBF in relation to clinical and psychological heterogeneity of mild cognitive impairment.Neuroimage 2003; 19(3):1137–1144.

    Article  PubMed  CAS  Google Scholar 

  40. Dulfano MJ, Ishikawa S. Hypercapnia: mental changes and extrapulmonary complication: an expanded concept of the “CO2 intoxication” syndrome.Ann Intern Med 1965; 63(5):829–841.

    PubMed  CAS  Google Scholar 

  41. Maeda Y, Kawasaki Y, Jibiki I, Yamaguchi N, Matsuda H, Hisada K. Effect of therapy with oxygen under high pressure on regional cerebral blood flow in the interval form of carbon monoxide poisoning: observation from subtraction of technetium-99m HMPAO SPECT brain imaging.Eur Neurol 1991; 31(6):380–383.

    Article  PubMed  CAS  Google Scholar 

  42. Watanabe N, Nohara S, Matsuda H, Sumiya H, Noguchi K, Shimizu M, et al. Statistical parametric mapping in brain single photon computed emission tomography after carbon monoxide intoxication.Nucl Med Commun 2002; 23(4):355–366.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Hulya Ortapamuk.

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Ortapamuk, H., Naldoken, S. Brain perfusion abnormalities in chronic obstructive pulmonary disease: comparison with cognitive impairment. Ann Nucl Med 20, 99–106 (2006). https://doi.org/10.1007/BF02985621

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