Chest
Volume 149, Issue 2, February 2016, Pages 426-434
Journal home page for Chest

Original Research: COPD
Structural Brain Changes in Patients With COPD

Some of the results have been presented as a poster at the European Respiratory Society International Congress, September 7, 2014, Munich, Germany.
https://doi.org/10.1378/chest.15-0027Get rights and content

Background

Patients with COPD suffer from chronic dyspnea, which is commonly perceived as highly aversive and threatening. Moreover, COPD is often accompanied by disease-specific fears and avoidance of physical activity. However, little is known about structural brain changes in patients with COPD and respective relations with disease duration and disease-specific fears.

Methods

This study investigated structural brain changes in patients with COPD and their relation with disease duration, fear of dyspnea, and fear of physical activity. We used voxel-based morphometric analysis of MRI images to measure differences in generalized cortical degeneration and regional gray matter between 30 patients with moderate to severe COPD and 30 matched healthy control subjects. Disease-specific fears were assessed by the COPD anxiety questionnaire.

Results

Patients with COPD showed no generalized cortical degeneration, but decreased gray matter in posterior cingulate cortex (whole-brain analysis) as well as in anterior and midcingulate cortex, hippocampus, and amygdala (regions-of-interest analyses). Patients’ reductions in gray matter in anterior cingulate cortex were negatively correlated with disease duration, fear of dyspnea, and fear of physical activity. Mediation analysis revealed that the relation between disease duration and reduced gray matter of the anterior cingulate was mediated by fear of physical activity.

Conclusions

Patients with COPD demonstrated gray matter decreases in brain areas relevant for the processing of dyspnea, fear, and antinociception. These structural brain changes were partly related to longer disease duration and greater disease-specific fears, which might contribute to a less favorable course of the disease.

Section snippets

Participants

Thirty stable outpatients with moderate to severe COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stage II and III)1 were recruited at the Pulmonary Research Institute (LungClinic Grosshansdorf; n = 20) and at an outpatient pulmonary rehabilitation center (Atem-Reha Hamburg; n = 10). Patients’ demographics and medical histories, including disease duration, were obtained from their medical records. Thirty control subjects without history of respiratory disease (FEV1 in

Participants

Means and SDs of baseline characteristics are reported in Table 1. Patients with COPD and control subjects did not differ significantly regarding age, sex, height, weight, and BMI. As expected, the COPD group showed lower lung function in FEV1 % predicted, FVC % predicted, and FEV1/FVC (all P < .001), and contained more smokers compared with the control group (P < .001). All participants were within the normal range of HADS anxiety and depression scores, that is, below the clinically relevant

Discussion

This study is one of the first to investigate structural brain changes in patients with COPD using VBM and several important findings were obtained. Patients with COPD showed no general reductions in MRI brain volume of gray matter, white matter, or total intracranial volume compared with matched healthy control subjects. In contrast, patients with COPD showed regionally decreased GMV within the PCC (whole-brain analysis) as well as in ACC, MCC, HC, and AMYG (small-volume analysis) when

Conclusions

Compared with healthy control subjects, patients with COPD showed decreased GMV in ACC, MCC, and PCC, HC, and AMYG in the absence of generalized cortical degeneration. The affected brain areas are involved in the processing of dyspnea, fear, and antinociception. Moreover, decreased gray matter in the ACC in patients with COPD was related to longer disease duration, and greater fear of dyspnea and fear of physical activity, which—via behavioral mechanisms—might negatively influence the course of

Acknowledgments

Author contributions: R. W. E. and A. v. L. had full access to all of the data in the study and take full responsibility for the integrity of the data and accuracy of the data analysis, including and especially any adverse effects. R. W. E., M. C. S., H. M., and A. v. L. contributed to study conception and design; R. W. E., M. C. S., A. K., H. W., K. T., and K. L. contributed to data acquisition; R. W. E., M. C. S., S. P., and A. v. L. contributed to data analysis and interpretation of data; R.

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