Cognition and chronic hypoxia in pulmonary diseases

Areza-Fegyveres, Renata; Kairalla, Ronaldo A.; Carvalho, Carlos R.R.; Nitrini, Ricardo

doi:10.1590/S1980-57642010DN40100003

Abstract

Lung disease with chronic hypoxia has been associated with cognitive impairment of the subcortical type. Objectives: To review the cognitive effects of chronic hypoxia in patients with lung disease and its pathophysiology in brain metabolism. Methods: A literature search of Pubmed data was performed. The words and expressions from the text subitems including "pathophysiology of brain hypoxia", "neuropsychology and hypoxia", "white matter injury and chronic hypoxia", for instance, were key words in a search of reports spanning from 1957 to 2009. Original articles were included. Results: According to national and international literature, patients with chronic obstructive pulmonary disease and sleep obstructive apnea syndrome perform worse on tests of attention, executive functions and mental speed. The severity of pulmonary disease correlates with degree of cognitive impairment. These findings support the diagnosis of subcortical type encephalopathy. Conclusion: Cognitive effects of clinical diseases are given limited importance in congresses and symposia about cognitive impairment and its etiology. Professionals that deal with patients presenting cognitive loss should be aware of the etiologies outlined above as a major cause or potential contributory factors, and of their implications for treatment adherence and quality of life.

Key words:
chronic hypoxia; brain; cognitive impairment; neuropsychological tests; encephalopathy of the subcortical type

Resumo

As doenças pulmonares que cursam com hipóxia crônica tem sido associadas à alteração cognitiva do tipo subcortical. Objetivo: Revisar os efeitos cognitivos da hipóxia crônica em pacientes com doenças pulmonar e sua fisiopatologia. Métodos: Foi utilizado o banco de dados do Pubmed. As palavras e expressões foram os temas dos subitens da revisão como, por exemplo, "fisiopatologia e hipóxia cerebral", "neuropsicologia e hipoxia", "lesões de substância branca e hipóxia crônica", variando de 1957 to 2009. Artigos originais foram incluídos. Resultados: De acordo com a literatura nacional e internacional, pacientes com doença pulmonar obstrutiva crônica e síndrome da apnéia obstrutiva do sono apresentam desempenho pior em testes neuropsicológicos que avaliam atenção, funções executivas e velocidade de processamento mental. Esses achados configuram uma encefalopatia do tipo subcortical. Conclusion: É dada importância limitada às conseqüências cognitivas das doenças clínicas em congressos e simpósios sobre cognição e suas etiologias. Profissionais que lidam com pacientes que apresentam perda cognitiva devem suspeitar das etiologias mencionadas acima com causa principal ou como co-fatores, assim com suas implicações na aderência ao tratamento e qualidade de vida.

Palavras-chave:
hipóxia crônica; cérebro; alteração cognitiva; testes neuropsicológicos; encefalopatia do tipo subcortical

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Publication Dates

Publication in this collection
Jan-Mar 2010

History

Received
06 Nov 2009
Accepted
17 Jan 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Blass JP, Gibson GE. Consequences of mild, graded hypoxia. Adv Neurol 1979;26:229-250.

[2] ²
Kirsch DB, Jozefowicz RF. Neurologic complications of respiratory disease. Neurol Clin 2002;20:247-264.

[3] ³
Freedmann BJ. Papilloedema, optic atrophy, and blindness due to emphysema and chronic bronchitis. Br J Ophthalmol 1963;47:290-294.

[4] ⁴
Tuder RM, Yun JH, Bhunia A, Fijalkowska I. Hypoxia and chronic lung disease. J Mol Med 2007;85:1317-1324.

[5] ⁵
Austen FK, Carmichael MW, Adams R. Neurologic manifestations of chronic pulmonary insufficiency. N Eng J Med 1957;257:579-90.

[6] ⁶
Kilburn K, Durham NC. Neurologic manifestations of respiratory failure. Arch Intern Med 1965;116:409-415.

[7] ⁷
Dulfano MJ, Ishikawa S. Hypercapnia: mental changes and extrapulmonary complications. An expanded concept of the "CO2 intoxication" syndrome. Ann Inter Med 1965;63:829-841.

[8] ⁸
Ackland GL, Noble R, Hanson MA. Red nucleus inhibits breathing during hypoxia in neonates. Respir Physiol 1997; 110:251-260.

[9] ⁹
Casanova C, Cote C, Marin JM, et al. Distance and oxygen desaturation during the 6-min walk test as predictors of long-term mortality in patients with COPD. Chest 2008; 134:746-752

[10] ¹⁰
Santos DB, Viegas CAA. Correlation of levels of obstruction in COPD with lactate and six-minute walk test. Rev Port Pneumol 2009;15:11-25.

[11] ¹¹
Casanova C, Hernández MC, Sánchez A, et al. Twenty-four-hour ambulatory oximetry monitoring in COPD patients with moderate hypoxemia. Respir Care 2006;51:1416-1423.

[12] ¹²
Mueller P de T, Gomes MD, Viegas CA, Neder JA. Systemic effects of nocturnal hypoxemia in patients with chronic obstructive pulmonary disease without obstructive sleep apnea syndrome. J Bras Pneumol 2008;34:567-574

[13] ¹³
Zanchet RC, Viegas CA. Nocturnal desaturation: predictors and the effect on sleep patterns in patients with chronic obstructive pulmonary disease and concomitant mild daytime hypoxemia. J Bras Pneumol 2006;32:207-212.

[14] ¹⁴
Sum M-K, Reis DJ. Hypoxia selectively excites vasomotor neurons of rostral ventrolateral medulla in rats. Am J Physiol Regul Integr Comp Physiol 1994;266:245-256.

[15] ¹⁵
Horn EM, Waldrop TG. Oxygen-sensing neurons in the caudal hypothalamus and their role in cardiorespiratory control. Respir Physiol 1997;110:219-228.

[16] ¹⁶
Koos BJ, Chau A, Matsuura M, Punla O, and Kruger L. Thalamic locus mediates hypoxic inhibition of breathing in fetal sheep. J Neurophysiol 1998;79:2383-2393.

[17] ¹⁷
Solomon IC, Edelman NH, Neubauer JÁ. The pre-Botzinger complex functions as a central hypoxia chemoreceptor for respiration in vivo. J Neurophysiol 2000;83:2854-2868.

[18] ¹⁸
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