Screening for neuropsychological impairment in COPD patients undergoing rehabilitation

Antonia Pierobon, Laura Ranzini, Valeria Torlaschi, Elisa Sini Bottelli, Anna Giardini, Claudio Bruschi, Roberto Maestri, Simona Callegari, Rita Raccanelli, Marinella Sommaruga

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a complex multi-component disorder characterized by progressive irreversible respiratory symptoms and extrapulmonary comorbidities, including anxiety-depression and mild cognitive impairment (MCI). However, the prevalence of these impairments is still uncertain, due to non-optimal screening methods. This observational cross-sectional multicentre study aimed to evaluate the prevalence of anxiety-depressive symptoms and MCI in COPD patients, identify the most appropriate cognitive tests to screen MCI, and investigate specific cognitive deficits in these patients and possible predictive factors.

MATERIALS AND METHODS: Sixty-five stable COPD inpatients (n = 65, aged 69.9±7.6 years, mainly stage III-IV GOLD) underwent the following assessments: Hospital Anxiety and Depression Scale (HADS), Geriatric Depression Scale (GDS) or Beck Depression Inventory-II (BDI-II), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and a complete neuropsychological battery (ENB-2) including different cognitive domains (attention, memory, executive functions, and perceptive and praxis abilities).

RESULTS: Moderate-severe anxiety was present in 18.5% of patients and depressive symptoms in 30.7%. The prevalence of MCI varied according to the test: 6.2% (MMSE), 18.5% (MoCA) and 50.8% (ENB-2). In ENB-2, patients performed significantly worse compared to Italian normative data on digit span (5.11±0.9 vs. 5.52±1.0, p = 0.0004), trail making test-B (TMT-B) (176.31±99.5 vs. 135.93±58.0, p = 0.004), overlapping pictures (26.03±8.9 vs. 28.75±8.2, p = 0.018) and copy drawing (1.370.6 vs. 1.61±0.5, p = 0.002). At logistic regression analysis, only COPD severity (p = 0.012, odds ratio, OR, 4.4 [95% CI: 1.4-14.0]) and anxiety symptoms (p = 0.026, OR 4.6 [1.2-17.7]) were significant and independent predictors of the deficit in copy drawing, which assesses visuospatial and praxis skills.

CONCLUSION: Given the prevalence of neuropsychological impairments in COPD patients, the routine adoption in rehabilitation of screening tools for mood and cognitive function, including digit span, TMT-B and copy drawing, may be useful to detect psychosocial comorbidities and personalize the rehabilitative program.

Original languageEnglish
Pages (from-to)e0199736
JournalPLoS One
Issue number8
Publication statusPublished - 2018


  • Aged
  • Aged, 80 and over
  • Anxiety/etiology
  • Cognition Disorders/etiology
  • Cognitive Dysfunction/diagnosis
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mental Status and Dementia Tests
  • Middle Aged
  • Odds Ratio
  • Pulmonary Disease, Chronic Obstructive/complications
  • Severity of Illness Index
  • Trail Making Test


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