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Relationship in Chronic Obstructive Pulmonary Disease

Igor Grant, MD; George P. Prigatano, PhD; Robert K. Heaton, PhD; A. John McSweeny, PhD; Elizabeth C. Wright, MPH; Kenneth M. Adams, PhD

Arch Gen Psychiatry. 1987;44(11):999-1006.

Abstract
• In previous work we showed that patients with chronic obstructive pulmonary disease (COPD) suffered decrements in neuropsychologic functioning suggestive of organic mental disturbance. This study combined data from two multicenter clinical trials to explore the nature and possible determinants of such neuropsychologic change. Three groups of patients with COPD whose hypoxemia was mild (N = 86), moderate (N =155), or severe (N = 61) were compared with age- and education-matched nonpatients (N = 99). The rate of neuropsychologic deficit rose from 27% in mild hypoxemia to 61% in severe hypoxemia. Various neuropsychologic abilities declined at different rates, suggesting differential vulnerability of neuropsychologic functions to progress of COPD. Multivariate analyses revealed a consistent significant relationship between degree of hypoxemia and neuropsychologic impairment, but the amount of shared variance was small (7%). Increasing age and lower education were also associated with impairment.

Author Affiliations
From the Veterans Administration Medical Center, La Jolla, and Department of Psychiatry, University of California at San Diego (Dr Grant); Section of Neuropsychology, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix (Dr Prigatano); Department of Psychiatry, University of Colorado, Denver (Dr Heaton); Department of Psychiatry, Medical College of Ohio, Toledo (Dr McSweeny); Biostatistics Center, George Washington University, Bethesda, Md (Ms Wright); and Department of Psychiatry, Henry Ford Hospital, Detroit (Dr Adams).

Footnotes
Accepted for publication April 8, 1986.

Reprint requests to Psychiatry Service (116), Veterans Administration Medical Center, San Diego, CA 92161 (Dr Grant).

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