Impact of cognitive impairment on asthma control in older asthmatics

Gyu-Young Hur; Young-Min Ye; So Young Moon; Joo-Hee Kim; Ki-Suck Jung; Hae-Sim Park

doi:10.4168/aard.2017.5.1.34

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Hur, Ye, Moon, Kim, Jung, and Park: Impact of cognitive impairment on asthma control in older asthmatics

Original Article

Allergy, Asthma & Respiratory Disease 2017; 5(1): 34-40.

Published online: 31 January 2017

DOI: https://doi.org/10.4168/aard.2017.5.1.34

Impact of cognitive impairment on asthma control in older asthmatics

Gyu-Young Hur^1,^*, Young-Min Ye^2,^*, So Young Moon³, Joo-Hee Kim⁴, Ki-Suck Jung⁴, Hae-Sim Park²

¹Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.

²Department of Allergy and Immunology, Ajou University School of Medicine, Suwon, Korea.

³Department of Neurology, Ajou University School of Medicine, Suwon, Korea.

⁴Department of Pulmonary & Allergy, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Korea.

Correspondence to: Hae-Sim Park. Department of Allergy & Clinical Immunology, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea. Tel: +82-31-219-5196, Fax: +82-31-219-4265, hspark@ajou.ac.kr

Equal contributor:

*These authors contributed equally to this study and should be considered co-first authors.

Received 1 September 2016 Revised 24 October 2016 Accepted 25 October 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

Assessment of the severity and clinical course of asthma is important for effective disease control. Cognitive and physical impairments occur due to the aging process, which may impact on asthma control. We aimed to evaluate the impact of cognitive function on the assessment of asthma control in older asthmatics as a prospective interventional trial.

Methods

A total of 50 mild to moderate asthmatics over 60 years of age were enrolled. Three questionnaires were used: the asthma control test (ACT), the asthma-specific quality of life, and the Korean version of the Short Form of the Geriatric Depression Scale. The Seoul neuropsychological screening battery-dementia version (SNSB-D), Korean version of the Mini-Mental Status Examination, and the Seoul instrumental activities of daily living scale were applied for neuropsychological assessment.

Results

The mean patient age was 67.0±4.9 years, and 30 patients (60.0%) were female. The sensitivity and specificity of the ACT for determining well-controlled asthma were 91.7% and 39.5%, respectively. Regarding neuropsychological assessment, 22 patients (44%) had mild cognitive impairment, 4 (8.7%) had dementia, and 17 (34%) had depression. Total SNSB-D score was significantly higher in patients with an ACT score of ≥20 (P=0.015). The ACT scores were significantly associated with SNSB-D results in analyses adjusted for age, sex, education duration, lung function, and depression (P=0.004).

Conclusion

We found significant positive correlations between cognitive functions, as measured by SNSB-D, and asthma control status, as measured by ACT scores, in older patients with asthma. Therefore, cognitive impairment may be associated with poor asthma control in older asthmatics.

Keywords: Asthma, Control, Older, Cognitive function

Figures and Tables

Fig. 1

Comparison of asthma control status as assessed by the asthma control test (ACT) score and Global Initiative for Asthma classification.

Table 1

Clinical characteristics of the study subjects (n=50)

Characteristic	Value
Age (yr)	67.0 ± 4.9
Female sex	30 (60.0)
Atopy	10/19 (52.6)
Duration of asthma	7.24 ± 5.00
Smoking	3 (6.0)
Education (yr)	9.45 ± 4.8
< Elementary school	15 (30.0)
Middle school	13 (26.0)
High school	14 (28.0)
> College graduate	8 (16.0)
FEV₁%	92.6 ± 19.8
FEF_25%–75%	70.1 ± 29.4
AQoL	99.9 ± 19.5 (25–120)
ACT	20.6 ± 3.9 (8–25)
MCI	22 (44.0)
Dementia	4/46 (8.7)
SNSB-D	207.9 ± 33.5
K-MMSE	26.8 ± 4.3
S-IADL	2.83 ± 3.56
Depression (SGDS-K ≥ 6)	17 (34.0)
SGDS-K	4.6 ± 4.2 (0–14)
6-Min walk test (m)	404.5 ± 92.7 (100–660)

Values are presented as mean±standard deviation or number (%).

FEV₁, forced expiratory volume in 1 second; FEF_25%–75%, forced expiratory flow at 25%–75% of lung volume; AQoL, asthma quality of life; ACT, asthma control test; MCI, mild cognitive impairment; SNSB-D, dementia version of the Seoul neuropsychological screening battery; K-MMSE, Korean version of the Mini Mental Status Examination; S-IADL, Seoul-Instrumental Activities of Daily Living Scale; SGDS-K, Korean version of the Short Form of the Geriatric Depression Scale.

Table 2

Clinical findings according to asthma control status (measured by the ACT score and GINA classification)

Characteristic	Asthma control (by ACT)			Asthma control (by GINA)
Characteristic	Well-controlled (20–25)	Poorly controlled (5–19)	P-value	Well-controlled	Poorly controlled	P-value
No. of patients	34 (68.0)	16 (32.0)		12 (24.0)	38 (76.0)
Age (yr)	66.06 ± 4.92	69.00 ± 4.19	0.045	66.00 ± 5.29	67.32 ± 4.74	0.419
Female sex	21 (61.8)	9 (56.2)	0.763	3 (25.0)	27 (71.1)	0.007
Atopy^*	9/13 (69.2)	1/6 (16.7)	0.057	4/5 (80.0)	6/14 (42.9)	0.303
Duration of asthma (yr)	7.08 ± 4.99	7.64 ± 5.24	0.767	9.00 ± 5.10	6.83 ± 4.97	0.308
Smoking	2 (5.9)	1 (6.3)	1.000	1 (8.3)	2 (5.3)	1.000
Education (yr)	9.84 ± 4.87	8.63 ± 4.66	0.409	12.5 ± 5.30	8.49 ± 4.25	0.010
FEV₁%	96.36 ± 15.9	84.78 ± 24.92	0.052	93.67 ± 12.26	92.33 ± 21.73	0.791
FEF_25%–75%	76.99 ± 28.26	55.51 ± 27.14	0.014	74.96 ± 31.05	68.59 ± 21.11	0.538
AQoL	106.94 ± 13.17	85.06 ± 22.61	< 0.001	109.50 ± 10.36	96.92 ± 20.78	0.050
ACT	-	-	-	23.42 ± 1.93	19.71 ± 3.96	< 0.001
SNSB-D	217.32 ± 24.41	187.96 ± 41.57	0.016	218.79 ± 23.14	204.49 ± 35.72	0.200
K-MMSE	27.71 ± 1.94	25.23 ± 6.72	0.299	27.27 ± 2.65	26.65 ± 4.93	0.698
S-IADL	2.67 ± 3.28	3.23 ± 4.32	0.634	1.64 ± 1.86	3.20 ± 3.89	0.079
SGDS-K	3.91 ± 4.04	6.19 ± 4.18	0.073	2.00 ± 2.00	5.47 ± 4.37	< 0.001
6-Min walk test (m)	415.06 ± 71.66	382.09 ± 126.35	0.245	455.33 ± 89.15	388.46 ± 88.91	0.028

Values are presented as number (%) or mean±standard deviation.

ACT, asthma control test; GINA, Global Initiative for Asthma; FEV₁, forced expiratory volume in 1 second; FEF25%–75%, forced expiratory flow at 25%–75% of lung volume; AQoL, asthma quality of life; ACT, asthma control test; SNSB-D, dementia version of the Seoul neuropsychological screening battery; K-MMSE, Korean version of the Mini Mental Status Examination; S-IADL, Seoul-Instrumental Activities of Daily Living Scale; SGDS-K, Korean version of the Short Form of the Geriatric Depression Scale.

^*Analyzed using Fisher exact test.

Table 3

Results of cognitive function test (SNSB-D) according to asthma control status measured by ACT and GINA

Domain (score)	Asthma control (by ACT)			Asthma control (by GINA)
Domain (score)	Well-controlled (20–25)	Poorly controlled (5–19)	P-value	Well-controlled	Poorly controlled	P-value
Attention (17)	10.82 ± 2.29	9.13 ± 2.63	0.024	11.25 ± 2.45	9.97 ± 2.48	0.125
Language and related function (27)	23.21 ± 3.24	21.13 ± 4.65	0.072	23.83 ± 2.12	22.13 ± 4.16	0.182
Visuospatial function (36)	34.65 ± 2.35	30.56 ± 7.23	0.042	34.54 ± 3.56	32.96 ± 5.16	0.329
Memory (150)	91.65 ± 14.47	78.59 ± 19.41	0.011	90.92 ± 10.41	86.38 ± 18.77	0.296
Frontal/executive function (70)	56.97 ± 8.39	49.19 ± 13.88	0.051	58.75 ± 9.55	53.13 ± 11.13	0.122
Total score (300)	217.32 ± 24.41	187.96 ± 41.57	0.016	218.79 ± 23.14	204.49 ± 35.72	0.200

Values are presented as mean±standard deviation.

SNSB-D, dementia version of the Seoul neuropsychological screening battery; ACT, asthma control test; GINA, Global Initiative for Asthma.

Table 4

Factors associated with the ACT score

Factor	Unadjusted^*		Adjusted^*
Factor	β (CI)	P-value	β (CI)	P-value
Measurement
K-MMSE	0.143 (−0.174–0.460)	0.366	−0.090 (−0.473–0.293)	0.634
S-IADL	−0.092 (−0.409–0.224)	0.559	−0.052 (−0.361–0.256)	0.734
SGDS-K	−0.325 (−0.578–−0.071)	0.013	−0.332 (−0.610–−0.55)	0.020
SNSB-D (score)
Attention (17)	0.531 (0.107–0.956)	0.015	0.309 (−0.193–0.811)	0.221
Language and related function (27)	0.338 (0.058–0.617)	0.019	0.217 (-0.182–0.615)	0.279
Visuospatial function (36)	0.460 (0.268–0.652)	< 0.001	0.458 (0.240–0.675)	< 0.001
Memory (150)	0.090 (0.029–0.151)	0.005	0.066 (−0.003–0.135)	0.059
Frontal/executive function (70)	0.168 (0.077–0.259)	0.001	0.154 (0.038–0.270)	0.010
Total score (300)	0.059 (0.030–0.089)	< 0.001	0.057 (0.020–0.094)	0.004

ACT, asthma control test; CI, confidence interval; K-MMSE, Korean version of the Mini Mental Status Examination; S-IADL, Seoul-Instrumental Activities of Daily Living Scale; SGDS-K, Korean version of the Short Form of the Geriatric Depression Scale; SNSB-D, dementia version of the Seoul neuropsychological screening battery.

^*Adjusted for age, gender, education, FEF25-75%, and SGDS-K.

Notes

This study was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (HI14C1061).

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ORCID iDs: Hae-Sim Park
https://orcid.org/http://orcid.org/0000-0003-2614-0303
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