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Prevalencia de deterioro cognitivo leve en pacientes ambulatorios con enfermedad pulmonar obstructiva crónica: estudio transversal en Bogotá, Colombia
Prevalence of mild cognitive impairment among outpatients with chronic obstructive pulmonary disease: A cross-sectional study in Bogotá, Colombia
DOI:
https://doi.org/10.15446/revfacmed.v74.120532Palabras clave:
Enfermedad Pulmonar Obstructiva Crónica, Prevalencia, Disfunción Cognitiva, Demencia, Pacientes Ambulatorios (es)Chronic Obstructive Pulmonary Disease, Prevalence, Cognitive Dysfunction, Dementia, Outpatients (en)
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Introducción. Ya que es una enfermedad sistémica, los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) pueden presentar deterioro cognitivo. En Colombia no hay estudios sobre la prevalencia de deterioro cognitivo, incluido el deterioro cognitivo leve (DCL), en esta población.
Objetivo. Determinar la prevalencia de DCL en pacientes con EPOC grave o muy grave atendidos en un centro de atención primaria de Bogotá (Colombia).
Materiales y métodos. Estudio transversal realizado en 139 pacientes con EPOC grave o muy grave atendidos en un centro de atención primaria de Bogotá entre mayo de 2019 y marzo de 2020. Se administró un cuestionario ad hoc (variables sociodemográficas) y la herramienta Montreal Cognitive Assessment (MoCA). También se obtuvo información sobre VEF1, relación VEF1/CVF, PaO2 y grado de hipoxemia (historias clínicas). Se consideraron dos puntos de corte para DLC: <26 y <21, este último se usó porque ha sido recomendado para población adulta mayor colombiana. Se exploró la asociación entre la presencia de DCL según cada punto de corte y el sexo y el nivel educativo (prueba de chi cuadrado de independencia con cálculo de Odds Ratio crudos).
Resultados. La edad promedio de los pacientes fue 72.07 años, 51.80% eran mujeres, 51.79% tenía un nivel socioeconómico bajo, 79.14% tenían escolaridad básica primaria y 54.68% tenía hipoxemia severa. Respecto a la puntuación en el MoCA, 49.64% obtuvieron <26 puntos y 17.27 % <21. Los dominios cognitivos más comprometidos fueron Recuerdo diferido y Capacidad visuoespacial/ejecutiva (54.68% y 38.13% de los participantes obtuvieron ≤2 puntos, respectivamente). Tener solo educación primaria se asoció significativamente con mayor riesgo de DCL, especialmente en el punto de corte <21 (OR: 7.33; IC95%: 1.08-315.22; p=0.02).
Conclusión. Casi la mitad de los pacientes con EPOC evaluados presentó DCL usando el punto de corte recomendado por el instrumento MoCA (i.e., <26). Estos hallazgos respaldan la necesidad de incluir la evaluación cognitiva sistemática en el abordaje integral de esta población con instrumentos sensibles como el MoCA. Finalmente, tener un bajo nivel educativo (solo educación primaria) aumentó la probabilidad de DCL.
Introduction: Since chronic obstructive pulmonary disease (COPD) is a systemic disease, patients with this condition may present cognitive impairment. In Colombia, there are no studies on the prevalence of cognitive impairment, including mild cognitive impairment (MCI), in this population.
Objectives: To determine the prevalence of MCI in patients with severe or very severe COPD treated at a primary care center in Bogotá, Colombia.
Materials and Methods: Cross-sectional study conducted on 139 patients with severe or very severe COPD treated at a primary care center in Bogotá between May 2019 and March 2020. The Montreal Cognitive Assessment (MoCA) was administered, along with an ad hoc questionnaire covering sociodemographic variables. Information on FEV1, FEV1/FVC ratio, PaO2, and the degree of hypoxemia was also obtained from medical records. Two cutoff points for MCI were considered: <26 and <21. The latter cutoff was utilized because it has been specifically recommended for the Colombian older adult population. The association between MCI according to each cutoff point, sex, and educational level was explored using the chi-square test of independence with calculation of crude Odds Ratios.
Results: The mean age of the patients was 72.07 years, 51.80% were women, 51.79% had a low socioeconomic level, 79.14% had basic primary education, and 54.68% had severe hypoxemia. Regarding the MoCA score, 49.64% of participants scored <26 and 17.27% scored <21. The most compromised cognitive domains were delayed recall and visuospatial/executive ability, as 54.68% and 38.13% of participants obtained ≤2 points, respectively. Having only primary education was significantly associated with a higher risk of MCI, especially at the <21 cutoff point (OR: 7.33, 95%CI: 1.08-315.22, p=0.02).
Conclusion: Nearly half of the evaluated patients with COPD presented MCI when using the cutoff point recommended by the MoCA instrument (<26). These findings support the need to include systematic cognitive evaluation in the comprehensive management of this population, using sensitive instruments such as the MoCA. Finally, having a low educational level (primary education only) increased the probability of MCI.
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