Lung disease in middle age may be a risk factor for dementia later in life

November 26, 2018

Nov. 26--Middle-aged adults with lung disease may be at greater risk of developing dementia or cognitive impairment later in life, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In "Impaired Lung Function, Lung Disease, and Risk of Incident Dementia," Pamela L. Lutsey, MD, PhD, and a group of researchers report that both restrictive and obstructive lung diseases were associated with dementia, including Alzheimer's disease, and with mild cognitive impairment. The link was stronger for restrictive lung diseases, such as idiopathic pulmonary fibrosis and sarcoidosis, than it was for chronic obstructive pulmonary disease (COPD).

"Preventing dementia is a public health priority, and previous studies have suggested that poor lung health, which is often preventable, may be linked to a greater risk of developing dementia," said Dr. Lutsey, lead study author and an epidemiologist at the University of Minnesota's School of Public Health. "In this study, we looked at the long-term association between poor lung function and the risk of developing dementia, using high-quality measures."

The researchers analyzed data from more than 14,000 participants (average age: 54) in the Atherosclerosis Risk in Communities (ARIC) study who underwent spirometry, an important lung test, and were asked about their lung health. The group was followed for 23 years on average when they were assessed for dementia or cognitive impairment. During that time 1,407 instances of dementia were reported, either as a result of the assessment or after a review of hospital diagnostic codes.

The study found that compared to those without lung disease, the odds of dementia or mild cognitive impairment were: The study also found that low results on two spirometry tests--forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)--were associated with dementia. FEV1 is the amount of air a person can forcefully exhale in one second. FVC is a measurement of lung size.

According to the authors, possible explanations for these findings are that lung disease produced low blood oxygen levels, which in turn may have led to inflammation, stress and damage to the brain's blood vessels.

Study limitations included the fact that participants' lung function was assessed only at the beginning of the study and that many patients died before being assessed for dementia or cognitive impairment.

Because it was not a randomized, controlled trial, the study cannot prove a cause and effect relationship between lung disease and dementia or mild cognitive impairment.

If these associations are causal, the researchers wrote, this would give added weight to efforts to improve air quality and to help people quit smoking. These public health measures might also lower rates of dementia as well as decrease lung disease.

"Preventing lung disease is inherently important," Dr. Lutsey said. "If other studies confirm our study's findings, both individuals and policymakers will have an added incentive to make changes that protect lung health, as doing so may also prevent dementia."
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About the American Journal of Respiratory and Critical Care Medicine (AJRCCM):

The AJRCCM is a peer-reviewed journal published by the American Thoracic Society. The Journal takes pride in publishing the most innovative science and the highest quality reviews, practice guidelines and statements in pulmonary, critical care and sleep medicine. With an impact factor of 15.24, it is one of the highest ranked journals in pulmonology. Editor: Jadwiga Wedzicha, MD, professor of respiratory medicine at the National Heart and Lung Institute (Royal Brompton Campus), Imperial College London, UK.

About the American Thoracic Society:

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's more than 16,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes three journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology and the Annals of the American Thoracic Society.

The ATS will hold its 2019 International Conference, May 17-22, in Dallas, Texas, where world-renowned experts will share the latest scientific research and clinical advances in pulmonary, critical care and sleep medicine.

American Thoracic Society

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