About 90% of patients with chronic obstructive pulmonary disease (COPD) and frailty have mild cognitive impairment (MCI), and this group of patients has a greater likelihood of experiencing frequent exacerbations, according to a study published in Respiratory Medicine.
Researchers sought to determine the prevalence of frailty among individuals with stable COPD treated on an outpatient basis and to explore the relationships between frailty, MCI, and exacerbation frequency in individuals with COPD. The researchers defined frailty as a condition “characterized by physiological deterioration that increases the risk of poor health outcomes such as falls, incident disability, hospitalization, and mortality.”
The cross-sectional study enrolled 304 patients with COPD from 2 hospitals in Northern Taiwan from January 2019 to December 2020. All patients met the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 diagnostic criteria for COPD and had no hospitalizations or visits to the emergency room in the 3 months before enrollment. Their mean (SD) age was 71.93 (9.22) years (range, 47-96), 87% were male, and 85% had a history of smoking.
The Fried frailty criteria were used to determine a patient’s level of frailty, and the Montreal Cognitive Assessment (MoCA) was used to identify MCI. The COPD Assessment Test (CAT) was used to assess COPD symptom burden in daily life, and the overall burden of comorbidities was determined with the Charlson Comorbidity Index (CCI).
Of the cohort, 234 patients were without frailty, and 70 participants (23%) met the criteria for frailty. Patients who were considered frail were significantly older than those without frailty (mean 78 vs 70 years, respectively), with 50.0% of those classified as frail over 80 years of age. Participants with frailty also had higher CAT scores (P <.0001).
We observed that frailty, a common symptom of COPD, is also associated with MCI, which is a significant contributor to the likelihood that patients will experience frequent exacerbations.
With respect to MCI, the researchers found that patients considered frail had a significantly lower MoCA total score of 19 (P <.0001) compared with patients not considered frail, who had an average MoCA total score of 25.0 (4.06). Patients considered frail vs those not considered frail were significantly worse in almost all domains except the naming domain (P = .928).
Of those considered frail, 90% (n = 63) had MCI. Patients with frailty had increased odds of having MCI, according to logistic regression analysis. Compared with patients without frailty, the odds ratio (OR) of MCI in patients with frailty was more than 7 times greater (OR 7.920; 95% CI, 3.482-18.02). Multivariate statistical analysis showed that the OR of MCI remained more than 7-fold higher in patients with frailty after adjustment for sex, age, education, GOLD, CAT, CCI, anxiety, frailty, asthma, and emphysema (adjusted OR 7.267; 95% CI, 2.695-19.591).
COPD with vs without frailty also was associated with higher odds of frequent exacerbations (OR 2.486; 95% CI, 1.307-4.726) and this likelihood remained significant in multivariate statistical analysis (adjusted OR 2.709; 95% CI, 1.215-6.039).
Study limitations include the cross-sectional study design and the researchers’ inability to obtain information on in COPD disease course changes or frailty progression. Also, participants were recruited from 2 teaching hospitals and may not fully represent general community-dwelling patients with COPD.
“We observed that frailty, a common symptom of COPD, is also associated with MCI, which is a significant contributor to the likelihood that patients will experience frequent exacerbations,” stated the investigators. “Frailty is highly prevalent in COPD patients, so spotting frailty should make it simpler to group patients into prognostic groups and select the best course of action for better clinical outcomes.”