The presence of emphysema on chest imaging and mid-life cognition.

Background: Airflow obstruction is associated with cognitive dysfunction but studies have not assessed how emphysema, a structural phenotype of lung disease, might be associated with cognitive function independent from pulmonary function measured by spirometry. We aimed to determine the relationship between the presence of visually detectable emphysema on chest computed tomography (CT) imaging and cognitive function.
Methods: We examined 2491 participants, mean age of 50 years, from the Coronary Artery Risk Development in Young Adults study who were assessed for the presence of emphysema on chest CT imaging and had cognitive function measured 5 years later with a battery of six cognitive tests.
Results: Of those assessed, 172 (7%) had emphysema. After adjusting for age, sex, height, study centre, race, body mass index, education and smoking, visual emphysema was significantly associated with worse performance on most cognitive tests. Compared to those without emphysema, participants with emphysema performed worse on cognitive testing: 0.39 sd units lower (95% CI -0.53- -0.25) on the Montreal Cognitive Assessment, 0.27 sd units lower (95% CI -0.42- -0.12) on the Rey Auditory Verbal Learning Test, 0.29 sd units lower (95% CI -0.43- -0.14) on the Digit Symbol Substitution Test and 0.25 sd units lower (95% CI -0.42- -0.09) on letter fluency. Further adjustment for forced expiratory volume in 1 s (FEV ₁ ), peak FEV ₁ and annualised FEV ₁ decline did not attenuate these associations.
Conclusions: The presence of emphysema on chest CT is associated with worse cognitive function, independent of airflow obstruction. These data suggest that emphysema may be a novel risk factor for cognitive impairment.
Competing Interests: Conflict of interest: B.E. Henkle has nothing to disclose. Conflict of interest: L.A. Colangelo reports personal fees from ndd Medical Technologies outside the submitted work. Conflict of interest: M.T. Dransfield reports grants from the NIH, DoD, American Lung Association and Dept of Veteran Affairs; personal fees from AstraZeneca, Boerhringer Ingelheim, GlaxoSmithKline, Mereo, Pulmonx and PneumRx/BTG; and clinical trial support from AstraZeneca, Boehringer Ingelheim, Gala, GlaxoSmithKline, Nuvaira, Pulmonx, PneumRx/BTG and Yungjin, all outside the submitted work. Conflict of interest: L. Hou has nothing to disclose. Conflict of interest: D.R. Jacobs has nothing to disclose. Conflict of interest: B.T. Joyce has nothing to disclose. Conflict of interest: C.L. Pistenmaa reports grants from the Alpha 1 Foundation and Boehringer Ingelheim, and personal fees from Lancet Respiratory Medicine and Horizon, outside the submitted work. Conflict of interest: R.K. Putman reports grants from the National Institutes of Health outside the submitted work. Conflict of interest: S. Sidney has nothing to disclose. Conflict of interest: B. Thyagarajan has nothing to disclose. Conflict of interest: G.R. Washko reports serving on an advisory committee for Boehringer Ingelheim, CSL Behring, GlaxoSmithKline and Vertex; personal fees from Boehringer Ingelheim, CSL Behring, Janssen, Novartis, PulmonX and Vertex; serving on a data safety and monitoring board for PulmonX; received research support from Boehringer Ingelheim, BTG and Janssen, all outside the submitted work; has ownership and investment interest in Quantitative Image Solutions; and his spouse is an employee of Biogen. Conflict of interest: K. Yaffe has nothing to disclose. Conflict of interest: R. Kalhan reports grants and personal fees from AstraZeneca, personal fees from CVS Caremark and Aptus Health, grants and personal fees from GlaxoSmithKline, and personal fees from Boston Scientific and the Boston Consulting Group, outside the submitted work. Conflict of interest: K.M. Kunisaki reports personal fees from GlaxoSmithKline and Nuvaira, Inc., and contracted clinical trial support from Sanofi, outside the submitted work.
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