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ORIGINAL ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 35-38  

Assessment of cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease: A cross-sectional study


1 Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
2 Department of Neurology, Institute of Neuroscience, Kolkata, West Bengal, India
3 Undergraduate Student, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India

Date of Submission13-May-2019
Date of Decision21-Jun-2019
Date of Acceptance25-Jun-2019
Date of Web Publication11-Mar-2020

Correspondence Address:
Dr. Somnath Maity
Department of Pharmacology, College of Medicine and Sagore Dutta Hospital, 578 B.T. Road, Kamarhati, Kolkata - 700 058, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsbm.JNSBM_139_19

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   Abstract 


Introduction: Chronic obstructive pulmonary disease (COPD) is a major public health problem worldwide and associated with multiple systemic involvements. Long-term hypoxia leads to impaired cognitive function and hand dexterity. With the background of few previous researches, we have aimed to assess cognitive function and hand dexterity in the patients with COPD as well as correlation between them and with oxygen saturation (SpO2). Materials and Methods: Data were collected and compared between 52 stable mild-to-moderate hypoxemic COPD patients defined by the Global Initiative for Obstructive Lung Disease Guidelines and 48 age- and sex-matched healthy volunteers attending the outpatient department of a government hospital Kolkata, using a validated questionnaire Mini-Mental State Examination (MMSE) tool for the assessment of cognitive function and the Nine-Hole Peg Test for assessment of hand dexterity. Results: The median (interquartile range [IQR]) value of Hand Dexterity Test for the dominant hand for the test group was 22 (20–24) s, and for the control group, 19 (18–20) s (P < 0.001). The median MMSE scores (IQR) for test and control groups were 19.5 (18–22) and 28 (26–29), respectively (P < 0.001). There is a negative correlation between these two parameters (correlation coefficient Spearman's rho −0.747 with 95% confidence interval −0.824 to −0.649, P < 0.001). SpO2has negative correlation with hand dexterity (correlation coefficient Spearman's rho −0.772 with 95% confidence interval −0.840 to −0.676, P < 0.001) and a positive correlation with MMSE score (correlation coefficient Spearman's rho 0.899 with 95% confidence interval +0.846 to +0.934, P < 0.001). Conclusion: Patients with COPD have reduced cognitive ability and hand dexterity. Hypoxia shows a negative correlation with hand dexterity and a positive correlation with cognitive impairment.

Keywords: Chronic obstructive pulmonary disease, cognitive impairment, hand dexterity, Mini-Mental State Examination score


How to cite this article:
Das M, Maity S, Choudhury S, Faisal UH. Assessment of cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease: A cross-sectional study. J Nat Sc Biol Med 2020;11:35-8

How to cite this URL:
Das M, Maity S, Choudhury S, Faisal UH. Assessment of cognitive function and hand dexterity in patients with chronic obstructive pulmonary disease: A cross-sectional study. J Nat Sc Biol Med [serial online] 2020 [cited 2020 Jul 11];11:35-8. Available from: http://www.jnsbm.org/text.asp?2020/11/1/35/280123




   Introduction Top


Chronic Obstructive Pulmonary Disease (COPD) is an airway disease with systemic involvement and one of the leading causes of morbidity and death worldwide.[1] Although the pathology begins with airway limitations but it often extends to ventilation perfusion mismatch at the later stage of disease. It is frequently associated with cardiovascular disease, anemia and osteoporosis and psycho-social problems.[2] Long term hypoxemia reduces oxygen supply to the cerebral cortex.[3],[4],[5] and it leads to the expression of several pro-inflammatory markers (CRP, IL-6, IL-8, TNF-a, TGF-b and IL-1b). This pathological change triggers cognitive dysfunction[6],[7],[8],[9] and also gives rise to the defect in motor speed and coordination resulting in the delay to carrying out repetitive tasks.[10] Hypoxemia also reduces muscle mass, oxidative capacity of skeletal muscles and cross-sectional areas of type 1 fibers.[11],[12],[13] As a consequence, health-related quality of life in patients with COPD is adversely affected.[14] In few previous researches impairment of cognition and hand dexterity (fine movement) have been studied separately in COPD patients.[8],[9],[13] There is growing evidence of a relationship amongst these two entities.[15] Thus, we have aimed to assess impairment of cognitive function and hand dexterity in the patients with COPD, and the relationship between the two parameters as well as their correlation with oxygen saturation.


   Materials and Methods Top


A questionnaire-based cross-sectional analytical study was conducted among patients attending the Outpatient Department of Chest Medicine in a Government Medical College Hospital located in suburban Kolkata from May to July 2018. The study was commenced only after obtaining ethical approval of the same by the institutional ethics committee.

Inclusion and exclusion criteria

Stable chronic obstructive pulmonary disease (COPD) patients who were mild-or-moderate hypoxemic as defined by the Global Initiative for Obstructive Lung Disease Guidelines[16] and who were able to read and understand questionnaire and willing to sign written informed consent form before study participants were included in the study. The identity of all the patients was kept confidential. Patients who used to consume alcohol regularly; who were on long-term oxygen therapy; and patients with additional pulmonary and neurological disease, uncontrolled cardiac dysfunction, head injury, severe seizures, respiratory failure, and musculoskeletal problem that might have affect the use of upper extremity were excluded from the study.

A total number of 100 participants, of which 52 COPD patients and 48 age- and sex-matched healthy volunteers, were studied as control, and the data obtained between these two groups were compared.

Instruments used

Each patient was assessed using an instrument: Nine-Hole Peg[17] Test for hand dexterity and Mini-Mental State Examination (MMSE) Questionnaire[18],[19] for cognitive function. Pulse oximeter[20] was used to measure the oxygen saturation (SpO2) level. The Nine-Hole Peg Test is a tool for clinical measure of hand dexterity. It is a square board with 9 holes, spaced 3.2 cm apart and each hole is 1.3 cm deep with 9 wooden pegs. Dimensions of the pegs are 0.64 cm in diameter and 3.2 cm in length. The patient was instructed to pick up the pegs one at a time using his dominant hand and put them into the holes in any order until the holes were all filled with 9 pegs. Then, the patient was instructed to remove the pegs one at a time and return them to the container while stabilizing the peg board with nondominant hand. The time required for the process was recorded with a stopwatch. The same procedure was then performed with the nondominant hand also. The test was repeated thrice and the average of the result was taken. The MMSE Questionnaire consists of 11 questions which measures six areas of cognitive function: orientation, registration, attention, calculation, recall, and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment.[18] To measure the oxygen saturation, we used Fingertip pulse oximeter from ChoiceMMed Model: MD300C2. The analysis of all data was done using IBM SPSS statistics Version 20 New York, United States.


   Results Top


Fifty-two evaluable COPD patients and 48 healthy volunteers were included in the study. Except age, all the other parameters were not normally distributed (nonparametric data) as per the Kolmogorov–Smirnov test for normality. Demographic characteristics and baseline parameters in both test and control groups are comparable as depicted in [Table 1]. P values obtained using unpaired Student's t-test for age, Chi-square test for sex, and Mann–Whitney U-test for the rest of the parameters as the data are nonparametric. There was a significant difference in pulse and SpO2 between the test and control groups. In [Table 2], it was observed that the median values of the time taken to complete the Nine-Hole Peg Test by both the dominant and nondominant hands and the MMSE score exhibit a significance difference between the two groups. P values of this comparison obtained using Mann–Whitney U-test as the data were nonparametric. The time taken to complete the Nine-Hole Peg Test by dominant hand and MMSE score showed a negative correlation between them (the correlation coefficient: Spearman's rho −0.747 with 95% confidence interval −0.824 to −0.649 with the P <0.001), as presented by a scattered plot in [Figure 1]. The values of SpO2 negatively correlated with the time taken to complete the Nine-Hole Peg Test by dominant hand (correlation coefficient Spearman's rho −0.772 with 95% confidence interval −0.840 to −0.676 with P < 0.001) and positively correlated between with the MMSE score (correlation coefficient Spearman's rho 0.899 with 95% confidence interval +0.846 to +0.934 with P < 0.001) as shown in the scattered plot of [Figure 2] and [Figure 3], respectively.
Table 1: Comparison of the demographic and vital statistics between test (chronic obstructive pulmonary disease patient) and the control groups (healthy volunteers)

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Table 2: Comparison of the time taken to complete Nine-Hole Peg Test for both dominant and nondominant hands and Mini-Mental State Examination scores between the test group and the control group

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Figure 1: Scattered plot showing the negative correlation between Mini-Mental State Examination score and time taken to complete Nine-Hole Peg Test by dominant hand

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Figure 2: Scattered plot showing the negative correlation between time taken to complete Nine-Hole Peg Test by dominant hand and oxygen saturation

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Figure 3: Scattered plot showing the positive correlation between Mini-Mental State Examination score and oxygen saturation

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   Discussion Top


COPD is a complex multicomponent disorder which is associated with a wide range of psychological and social problems.[1],[2] Measure of disease severity such as airflow limitation is a poor marker of relevant patient outcome largely because it does not reflect the multisystem nature of the disease.[14] A number of comorbidities associated with COPD are of significant concern, especially for elderly people. Cognitive impairment characterized by memory loss and skeletal muscle dysfunction characterized by decreased muscle strength and endurance are of prime elements that may cause functional disability and decrease quality of life. A number of previous studies showed that reduced exercise capacity and muscle weakness render these patients disabled with a high utilization of health-care resource.[12],[13] A variety of measures are available for assessing upper extremity impairment.[1],[17] One among these was the Nine-Hole Peg Test. This test is a brief measure used to quantify hand dexterity. This test was applied in previous studies to assess the impairment of upper extremity in Post Stroke Patient and in patients with Parkinson's disease but it had not been applied to assess upper extremity weakness in patients with COPD.[17],[21] Long-term hypoxia reduces coordinated small muscle movement of the hand as the pathology is discussed earlier[10],[11],[12],[13] which is proved by finding a negative correlation between SpO2 and the time taken to complete the Nine-Hole Peg Test, as shown in [Figure 2]. Although in our study the time taken to complete the Nine-Hole Peg Test by both the dominant and nondominant hands was increased significantly in the patients with COPD as compared to the control, only the Nine-Hole Peg Test by the dominant hand was used to search the correlation with SpO2 and MMSE score as the dominant hand is used to execute most of our daily life activities. Previous works suggest the cognitive impairment and functional impairment that frequently occur in Patients with COPD were correlated with chronic hypoxia.[3],[8],[9] This study reveals a statistically significant cognition impairment in COPD group; the median (interquartile range [IQR]) MMSE score for the test group is 19.5 (18–22), which is categorized as mild-to-moderate cognitive impairment, and the control group median (IQR) MMSE score is 25.5 (23.25–29.0) which suggests normal cognitive status.[18],[19] Prolonged oxygen deprivation to the brain in COPD patients causes permanent brain damage results in neuropsychological impairment permanent[2],[4],[5] and frontal-type of cognitive declination.[3],[9] In this study, a positive correlation between SpO2 and MMSE score was found for the test group and the 95% confidence interval showed statistical significance. This implies that the cognitive impairment noted in COPD patients was higher in patients with coexisting chronic hypoxia. Moreover, an inverse correlation between MMSE score and the time taken to complete the Nine-Hole Peg Test by the dominant hand was documented which confirms that the cognition is necessary to execute the skilled or fine motor movements. Therefore, reduced cognitive ability coexisted with a decrease in hand dexterity in COPD patients.


   Conclusion Top


This study reveals the impairments in cognitive function and hand dexterity in the patients with COPD and their correlation with oxygen saturation. Cognitive impairment and hand dexterity impairment were proportional. Therefore, this study indicates that there is a hypoxemic origin for both cognitive and movement impairments. Further studies are required to qualify the types and neurobiology of these deficits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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