The Association Between Cognitive Functions and Psychological Factors in Patients with Severe COPD

Kristina Kock Hansen,1,2 Ole Hilberg,1,2 Hanne Irene Jensen,2,3 Anders Løkke,1,2 Ingeborg Farver-Vestergaard2,4 1Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark; 2Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; 3Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark; 4Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, DenmarkCorrespondence: Kristina Kock Hansen, Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Beriderbakken 4, Vejle, 7100, Denmark, Tel +45 20189828, Email kristina.kock.hansen2@rsyd.dkPurpose: Patients with COPD experience anxiety, depression, and stress more frequently than in the age and gender-matched general population. This cross-sectional study aimed to examine the relationship between cognitive functions and the psychological factors of anxiety, depression and stress among patients with COPD.Patients and Methods: Between January 2021 and January 2023, patients with severe COPD were recruited, along with age-matched controls. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS). The Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT), and a driving simulator were used to assess cognitive impairment. Hierarchical multiple linear regression analyses were used to explain the variance of the correlations.Results: In total, 80 patients (mean age = 64yrs) and 22 controls (mean age = 61yrs) participated in the study. Patients reported significantly higher levels of psychological symptoms compared to the controls (p ≤ 0.001). We found no differences in anxiety (p = 0.31), depression (p = 0.66) and stress (p = 0.37) between patients with and without cognitive impairment. However, stress showed to be a significant predictor of decreased attention (higher stress score resulted in decreasing CRT-index, indication a reduced stability in reaction time) (p = 0.02). Psychological factors did not explain additional variance in cognitive functions beyond sociodemographic factors such as age and sex.Conclusion: Psychological symptom levels are higher in COPD than controls and perceived stress among patients with COPD appears to be associated with decreased attention. However, psychological factors in general did not appear to contribute to the variance in cognitive functions beyond sociodemographic, physical, and self-perceived symptoms.Keywords: chronic obstructive pulmonary disease, cognitive impairment, Montreal Cognitive Assessment, anxiety, depression, stress