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August 1982

Neuropsychologic Findings in Hypoxemic Chronic Obstructive Pulmonary Disease

Author Affiliations

From the Psychiatry Service, San Diego Veterans Administration Medical Center (Dr Grant); the Departments of Psychiatry (Dr Grant) and Medicine (Dr Timms), University of California at San Diego School of Medicine, La Jolla; the Department of Psychiatry, University of Colorado School of Medicine, Denver (Dr Heaton); the Department of Psychiatry, Medical College of Ohio, Toledo (Dr McSweeny); the Department of Psychiatry, Henry Ford Hospital, Detroit (Dr Adams); and Scripps Clinic and Research Foundation, La Jolla, Calif (Dr Timms).

Arch Intern Med. 1982;142(8):1470-1476. doi:10.1001/archinte.1982.00340210062015

• As part of a six-center clinical trial of the effectiveness of continuous v nocturnal oxygen in the management of hypoxemic chronic obstructive pulmonary disease (COPD), we performed detailed neuropsychologic assessments of these patients prior to their beginning treatment. The 203 patients (age, 65 years; Pao2, 51 mm Hg; forced expiratory volume in 1 s, 0.74 L) performed significantly worse than controls on virtually all neuropsychologic tests. Moderate to severe test impairment suggestive of cerebral dysfunction was found in 42% of the patients, as compared with 14% of controls. Higher cognitive functions (abstracting ability, complex perceptual-motor integration) were most severely affected, although half the patients also showed decrements in motor speed, strength, and coordination. Low-order significant inverse correlations were found between neuropsychologic impairment and Pao2, resting arterial oxygen saturation and hemoglobin levels and maximum work. It is concluded that cerebral disturbance is common in hypoxemic COPD and may be related in part to decreased availability of oxygen to the brain.

(Arch Intern Med 1982;142:1470-1476)