Cognitive Impairment and COPD by Numbers
Cognitive impairment has an increased risk for mortality, similar to diabetes, high blood pressure or increased lipids according to Sach’s recent study. The study included nearly 4,000 primary care adults, aged 60 to 102, over a sixteen month period with tracking for more than thirteen years. Varying race with low socioeconomic class and three degrees of cognitive impairment were documented (none, mild and moderate to severe). Sach’s study was published in the September 6, 2011 issue of “Annals of Internal Medicine”.
Study outcome showed 138 months survival time baseline with no cognitive impairment at the start of study versus 106 months (11.5 years) survival for mild cognitive impairment (nearly 2 years or 11% sooner) and 63 months moderate to severe cognitive impairment (6.5 years or 21% sooner). Chronic diseases like Alzheimer’s, cancer and congestive heart failure share a prognosis of 3 to 6 years from diagnosis to death.
Lower life expectancy may effect decisions for advanced care planning, cancer treatment planning, and prevention drug prescriptions. For example, it may not make sense to provide a colonoscopy cancer screening for a 90 year old with severe cognitive impairment. Even when someone does not meet the criteria for dementia screening, finding the source of cognitive impairment could be life saving. Benefit could be provided both long and short term. Compared to other tests, cognitive evaluation being linked to prognosis could be more effective. Re-evaluating patient at risk of falls and improvement of chronic conditions like diabetes and congestive heart failure that may be poorly controlled because of problems with medications or adherence to the care plan, could be beneficial, also.
Chronic Obstructive Pulmonary Disease is now the third leading cause of Death in the United States.
Ranking after heart disease and cancer, with 120,000 deaths each year, COPD costs $50 billion each year in medical bills and loss of productivity. COPD consists of Emphysema and Bronchitis, which are degenerations of the bronchioles (tiny airways) and alveoli (air sacs). The single leading cause for COPD is smoking, however, according to researchers twenty per cent is due to environmental and occupational exposures. COPD affects about 12 million American adults. About one in every 17 adults is affected by COPD, 6% are women and 4% are men. COPD is not an equal opportunity disease; more than 8% below poverty level have COPD. One third of Medicare COPD patients do not take prescribed medications because of the cost of inhalers. Fifty per cent of people with COPD have between 6-10 other medical conditions and twenty per cent have more than 11 other medical conditions.
The five primary symptoms of COPD are cough, wheezing, chest tightness, extreme mucus production, and shortness of breath, especially with exercise.