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Visual rating assessment of cerebral atrophy and its relationship with cognitive function in chronic obstructive pulmonary disease
  1. Charlotte Claire Savage1,
  2. Piers Henry Anderson Dixey2,
  3. Catherine Pennington3 and
  4. James W Dodd2
  1. 1 Faculty of Health Sciences, University of Bristol, Bristol, UK
  2. 2 Academic Respiratory Unit, Clinical Sciences, University of Bristol, Bristol, UK
  3. 3 Neurology, School of Clinical Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr James W Dodd; james.dodd{at}; james.dodd{at}


Introduction Widespread white matter damage and cognitive impairment have been demonstrated in chronic obstructive pulmonary disease (COPD). However, it remains unclear if brain atrophy is a global phenomenon or if specific subregions are differentially affected. The aims of this study are, first, to test a simple, validated visual analogue grading technique. Second, we hypothesised that frontal regions of the brains of patients with COPD will show greater signs of atrophy compared with control subjects. Third, any localised regions of atrophy would correlate with components of cognitive performance. Finally, the severity of cerebral atrophy would be associated with measures of respiratory disease severity.

Methods We used a simple, validated visual analogue grading technique to assess the degree of regional atrophy in multiple brain regions from cerebral MR images in patients with stable non-hypoxaemic COPD (n=25) and age-matched control subjects (n=25). We also explored correlations between regional brain atrophy with demographics, cognitive performance measures and disease severity. Measures of cognitive performance focused on executive function, working memory, verbal memory, overall memory and processing speed. Measures of disease severity include lung function, gas exchange, health status and breathlessness questionnaires.

Results The visual grading scale found that patients with COPD had significantly greater frontal atrophy than control subjects (p=0.02), independent of smoking history, comorbid depression or anxiety. Cognitive function was significantly worse in the COPD group for executive function (p<0.001), working memory (p=0.02), verbal memory (p=0.03) and processing speed (p=0.001). Group differences in atrophy did not appear to account for differences in cognitive function. We were unable to identify meaningful correlations between regional atrophy and disease severity or cognitive function.

Conclusion Further work is needed to identify causative mechanisms behind unexplained structural brain changes in COPD.

  • COPD pathology
  • COPD ÀÜ mechanisms

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  • Contributors JWD and CP conceived the presented idea. JWD provided data set from previous published research for the further analysis of this study. CCS performed image analysis and generation of results with CP. PHAD provided critical feedback and all authors contributed to shaping of the research. CCS wrote the manuscript with supervision from JWD, CP and PHAD.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Wandsworth and East Central London Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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