Cognitive performance in relation to metabolic disturbances in patients with COPD

Martijn van Beers, Harry R. Gosker, Daisy J. A. Janssen, Fiona A. H. M. Cleutjens, Frits M. E. Franssen, Martin P. J. van Boxtel, Emiel F. Wouters, Rudolf W. H. M. Ponds, Annemie M. W. J. Schols

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Background & aims: Cognitive impairment (CI) and metabolic abnormalities, including the metabolic syndrome (MetS) and sarcopenia, are more prevalent in COPD patients compared to controls without diagnosed lung disease. Because earlier studies have shown these metabolic abnormalities may affect cognitive performance, this study investigated whether cognitive performance is more impaired in subgroups of COPD patients with MetS or sarcopenia. Methods: Cognitive performance patterns of 170 COPD patients referred for pulmonary rehabilitation (53.5% male, 63.4 ± 9.4 years, FEV1 54.5 ± 22.7% predicted) were compared between COPD subgroups stratified by presence of MetS and sarcopenia. Cognitive performance was assessed using a detailed neuropsychological test battery, which measured psychomotor speed (Stroop Color-Word Test, Concept Shifting Test, Letter-Digit Substitution Test), planning (Behavioral Assessment of the Dysexecutive Syndrome), working memory (Visual-Verbal Learning Test, Digit Span), verbal memory (Visual-Verbal Learning Test) and cognitive flexibility (Stroop Color-Word Test, Concept Shifting Test). MetS was determined according to the NCEP ATP-III criteria. Sarcopenia was determined based on decreased appendicular lean mass by dual-energy x-ray absorptiometry and impaired physical performance by 6-min walking distance. Results: MetS was observed in 54.7% and sarcopenia in 30.0% of COPD patients. The prevalence of general CI was not different between patients with and without MetS (30.4% and 39.0%, respectively) or those with and without sarcopenia (34.0% and 34.5%, respectively, both p > 0.05). Domain-specific cognitive performance was not different between metabolic subgroups, but those with sarcopenia displayed a lower prevalence of CI on verbal memory than those without (21.7% and 29.7%, respectively, p = 0.011). Only the digit span (working memory) subtest was significantly different between metabolic subgroups, in favor of those without MetS (p = 0.017). Conclusion: Cognitive performance was not affected more in COPD patients with sarcopenia or MetS.
Original languageEnglish
Pages (from-to)2061-2067
Number of pages7
JournalClinical Nutrition
Issue number4
Publication statusPublished - 1 Apr 2021
Externally publishedYes


  • Chronic obstructive pulmonary disease
  • Cognitive impairment
  • Metabolic syndrome
  • Sarcopenia

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