Higher prevalence of MCI/dementia is seen in patients with COPD compared with age-matched controls. Imaging findings and dementia/MCI biomarkers provide preliminary evidence for an indirect association of the two conditions. Although no causality can be drawn with the available data, there is some indication that the severity of hypoxemia correlates with the severity of cognitive dysfunction.

Purpose of reviewAs life expectancy increases, the ageing population accrues an increasing burden of chronic conditions and functional compromise. Some conditions that lead to compromise are deemed part of natural ageing, whereas others are considered to represent disease processes. Ageing (a natural process) and chronic obstructive pulmonary disease (a disease) share many common features, both pulmonary and systemic. At times, the pathways of injury are the same, and at times they are concurrent. In some cases, age and disease are separated not by the presence but by the severity of a finding or condition. This brief review aims to compare some of the similarities between ageing and COPD and to compare/contrast mechanisms for each. Recent findingsAt the cellular level, the natural process of ageing includes multiple systemic and molecular mechanisms. COPD, though defined by progressive pulmonary compromise, can also be a systemic disease/process. It has become evident that specific senescence pathways like p-16 and the sirtuin family of proteins are implicated both in ageing and in COPD. Also common to both ageing and COPD are increased inflammatory markers, leucocyte response abnormalities, and DNA-level abnormalities.

Literature suggests racial implicit bias can significantly affect quality of care. Data demonstrates that older adult Blacks are twice as likely to have dementia as their White counterpart. Inappropriate cognitive screening by providers or diagnosing dementia just based on clinical impression could easily result in an over or under-estimation of the dementia. We reviewed the rate and method of cognitive screening in randomly selected patient records (n=75) at a primary care university clinic. Our results indicated that the cognitive screening rate for Black patients was lower compared to their White counterpart (43.4% Blacks vs 68.5% Whites, p < 0.05). We designed a quality improvement project to identify any contributory causes and challenges involved in screening for dementia with the goal to reduce racial disparity in dementia diagnosis. We identified knowledge deficits in providers in their approach towards patients with dementia and a lack of experience in their use of appropriate instruments for cognitive screening. A multipronged educational program, with videos, case conferences, presentations and one-to-one training by dementia experts and a neuropsychologist was employed to reduce the bias and train the providers in appropriate screening methods. Post-educational intervention, screening rates greatly improved in n=75 randomly selected patients from both races. In Whites, the screening rate increased by 20.9% to 89.4% and in Blacks by 38.9% to 82.3% (p < 0.05). Overall, the quality improvement driven educational intervention improved the self-efficacy of providers and improved the standardized dementia screening rates in Black patients to levels comparable to those of White patients.