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Gas Exchange and Exercise Capacity Affect Neurocognitive Performance in Patients With Lung Disease

Parekh, Priti I. PhD; Blumenthal, James A. PhD; Babyak, Michael A. PhD; LaCaille, Rick PhD; Rowe, Sarah BS; Dancel, Liz BS; Carney, Robert M. PhD; Davis, R Duane MD; Palmer, Scott MD; for the INSPIRE Investigators

Original Articles

Objective: This study examined the relationship between cognitive functioning and the severity of underlying lung disease in patients awaiting lung transplantation.

Methods: Ninety-four patients with end-stage lung disease completed a test battery to assess cognitive performance in two domains: executive functioning/attention (Trails A and B, COWA, Animal Naming, Stroop Color–Word Test, Digit Symbol, and the 2 & 7 Test) and verbal memory (Digit Span–Backward and Forward, WMS-R Logical Memory and Paired Verbal Associates).

Results: Thirty-seven percent of the patients demonstrated moderate to severe cognitive impairment data on two or more tests. Adjusting for age and education, there were no statistically significant differences on executive functioning or verbal memory as a function of specific lung disease diagnosis. Lower PCO2 values were associated with better cognitive performance on latent measures of executive functioning and attention (p = .006) and verbal memory (p = .009), whereas higher PO2 values tended to be associated with better performance on the executive functioning/attention measure (p = .064). Distance walked in 6 minutes was positively related to verbal memory (p < .023).

Conclusions: Impaired neurocognitive functioning may be relatively common in patients awaiting lung transplantation and is associated with ineffective pulmonary gas exchange and reduced exercise tolerance.

CFI = Bentler’s Comparative Fit Index; COPD = chronic obstructive pulmonary disease; FEV1 = percent predicted forced expiratory volume in one second; FVC = forced vital capacity; INSPIRE = Investigational Study of Psychological Intervention in Recipients of Lung Transplant; MANOVA = multivariate analysis of variance; PCO2 = arterial pressure of carbon dioxide in the blood; PO2 = arterial pressure of oxygen in the blood; RMSEA = root mean square error of application; TLFI = Tucker-Lewis Index; WAIS-R = Wechsler Adult Intelligence Scale–Revised; WMS-R = Wechsler Memory Scale–Revised.

From the Departments of Psychiatry and Behavioral Sciences (P.I.P., J.A.B., M.A.B., R.L., S.R., L.D.), Surgery (R.D.D.), and Medicine (S.P.), Duke University Medical Center, Durham, North Carolina; and the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (R.M.C.).

INSPIRE Investigators: James A. Blumenthal, PhD (Director, Behavioral Medicine); Robert M. Carney, PhD (Codirector, Behavioral Medicine); R. Duane Davis, MD (Surgical Director); Scott M. Palmer, MD (Medical Director); Michael A. Babyak, PhD, Robyn Claar, PhD, Iris Csik, MSW, Liz Dancel, BS, Francis J. Keefe, PhD, Kenneth Freedland, PhD, Elizabeth Gullette, PhD, Joel Hughes, PhD, Rick LaCaille, PhD, Kari Merrill, PhD, Melissa Napolitano, PhD, Jennifer Norten, PhD, Priti I. Parekh, PhD, Sarah Rowe, BS, Victor Tapson, MD, and Elbert Trulock, MD.

Address correspondence and reprint requests to James A. Blumenthal, PhD, Box 3119, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710. E-mail:

Received for publication June 10, 2004; revision received December 27, 2004.

This study was performed at Duke University Medical Center and was supported by NHLBI grant HL 65503–01.

Copyright © 2005 by American Psychosomatic Society
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