Cognitive impairment, depression, anxiety, and health-related quality of life in fibrotic ILD: a cross-sectional study.

backgroundComorbidities such as systemic hypertension, coronary artery disease, and pulmonary hypertension are common in interstitial lung diseases. These conditions may significantly affect treatment choice, outcomes, and health-related quality of life (HRQL). Few studies have investigated cognitive impairment (CI) in patients with idiopathic pulmonary fibrosis (IPF), and data on CI in hypersensitivity pneumonitis (HP) are lacking. We aimed to evaluate CI in a cohort of patients with fibrotic interstitial lung disease and to examine associated factors, including depression, anxiety, and their effects on HRQL.

methodsNinety-four patients with F-ILD were included in the study, and cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Turkish version of Montreal Cognitive Assessment (MoCA-TR). Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS). HRQL was evaluated using the Short Form-36 (SF-36).

resultsOf the 94 patients included, 61 (64.9%) were male, with a mean (standard deviation) age of 63.6 (SD: 10.6) years, and 62.8% had a history of smoking. The cohort included 45 (47.9%) with IPF and 49 (52.1%) with fibrotic HP patients. The mean FVC% predicted, and DLCO% were 72.2% (SD: 18.6) and 55.7% (SD: 20.7), respectively, and the mean 6-minute walk test (6MWT) distance was 350 (SD: 111) m. The mean MMSE and MoCA-TR scores were 22.3 (SD: 5.5) and 18.9 (SD: 5.7), both below established cutoff values. CI was identified in 51.1% of patients using MMSE and in 66.0% using MoCA-TR. Notably, MMSE-defined CI was more frequent in females, nonsmokers, patients with higher BMI, and those with anxiety, and was associated with lower physical functioning scores on SF-36. In contrast, when CI was defined by MoCA-TR, only a shorter 6MWT distance was related to CI. Depression and anxiety were present in 35 (37.2%) and 21 (22.3%) patients, respectively. Patients with anxiety were older than those without anxiety (68.9 (SD: 8.4) vs. 62.1 (SD: 10.7), p = 0.009), and anxiety was more frequent in females as well. Although BMI, DLCO%, 6MWT distance, and SF-36 subdomain scores demonstrated weak associations with cognitive scores, these findings help us better understand patient variability.

conclusionCI was observed in more than half of patients with F-ILD and was associated with functional limitations, anxiety, and impaired HRQL. Awareness of CI in this patient population is essential for healthcare professionals, as it may facilitate appropriate assessment, individualized patient-centered approaches, and the implementation of supportive care strategies.