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COPD & Cognitive Issues

COPD & Cognitive Issues

As the third leading cause of death in the United States, COPD affects about 13.7 million patients. Recent research has suggested that as many as 77% of patients with COPD and hypoxemia have some form of cognitive impairment. Despite this association, the link between COPD and mild cognitive impairment (MCI) has not been established in well-designed, population-based studies. Investigating the Link In a study published in Mayo Clinic Proceedings, Balwinder Singh, MD, MS, and colleagues analyzed data from 1,927 individuals aged 70 to 89 who participated in the Mayo Clinic Study of Aging to see if there was an association between COPD and MCI. Patients underwent a nurse assessment, neurological evaluation, and neuropsychological testing when they entered the study. A panel diagnosed MCI using standardized criteria and then reviewed medical records to identify people with COPD who developed MCI. According to the analysis, patients with COPD had a higher prevalence of MCI than those without COPD (27% vs 15%). Findings were similar for both men and women involved in the study. “In addition, COPD was associated with almost two-fold higher odds of MCI,” says Dr. Singh. The associations of COPD with overall MCI and amnestic MCI were independent of age, sex, education, apolipoprotein E genotype, BMI, depression, and a history of coronary artery disease, diabetes, hypertension, and stroke. The investigation also revealed that there appears to be a dose-response effect for COPD duration. “We observed a 1.60 odds ratio for MCI in patients who had COPD for 5 years or less, but this ratio jumped to 2.10 in patients who had a COPD duration that exceeded 5 years,” Dr....
Guidelines for Managing OSA in Adults

Guidelines for Managing OSA in Adults

Obstructive sleep apnea (OSA) is a common disorder that affects patients of all ages, especially those who are middle-aged and elderly. “Studies show that OSA rates are increasing in the United States, most likely because of rising obesity rates,” says Molly Cooke, MD. “Further complicating matters is that OSA is often misdiagnosed because its symptoms are not always specific to the disease.” In late 2013, the American College of Physicians (ACP) published guidelines in Annals of Internal Medicine that presented evidence and provided clinical recommendations on the management of OSA in adults. Using studies from 1966 to 2012, the ACP assessed several treatments that are designed to alleviate airway obstruction during sleep. “Our purpose was to present information on OSA interventions in order to determine the net benefits of these treatments,” says Dr. Cooke, who was on the ACP writing committee. She adds that the target audience for the guidelines includes all clinicians, and the target patient population comprises all adults with OSA. 3 Key Recommendations for Obstructive Sleep Apnea The ACP guidelines make three recommendations for treating OSA in adults (Table 1), and Dr. Cooke says the first line of defense should be weight loss. “Obesity is a risk factor for OSA,” she says. “All overweight and obese patients who have OSA should be encouraged to lose weight.” The evidence shows that some intensive weight-loss programs may effectively reduce signs and symptoms in obese patients with or without diabetes. Those signs and symptoms can include the apnea-hypopnea index (AHI), daytime sleepiness, and oxygen saturation. Weight loss is also associated with many health benefits other than for OSA. If...

Doc’s Defamation Lawsuit: The Patient’s Side

Are you familiar with a case in Minnesota where a doctor sued a patient’s son for defamation over a negative review he posted? Dr. David McKee’s defamation lawsuit, a 4-year legal battle ended up in the Minnesota Supreme Court. The story recently came up again because BuzzFeed posted an article entitled “Insult And Injury: How Doctors Are Losing The War Against Trolls” discussing how doctors are having trouble defending themselves against negative reviews. I tweeted a link to that article, and Dennis K. Laurion, whose father was the patient in the Minnesota, case wrote to me. He says no one ever asks him about his side of the story. He’s agreed to let me publish his comments: As one of the “trolls” detailed in the article, I have no issue with the accuracy of the text—at least as it pertains to me—but the tone of the title fails to distinguish sincere complaints about bedside manner from attacks on mental stability, attacks on medical prowess, fake websites, allegations of dangerous injections, and use of multiple identities. The author said “McKee [the doctor in the case] and Laurion agree on substance…”  (View excerpts of the case from various media outlets in unabridged letter here.) This entire experience has been distressing to my family. We were initially shocked and blindsided by “jocular” comments made so soon after my father’s stroke by somebody who didn’t know us. We were overwhelmed by my being sued after posting a consumer opinion, and we were shocked by the rapidity with which it happened. It has been the 800 pound gorilla in the room. My parents would...
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