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Title: Cognitive function and multimodal cranial MRI in chronic obstructive pulmonary disease
Author: Dodd, James W.
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2012
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Chronic Obstructive Pulmonary Disease (COPO) is frequently associated with eo- morbidities such as cardiovascular disease, lung cancer, depression and osteoporosis, leading to the widely accepted view that COPO is a complex multi- system disorder. Traditional measures of disease severity, such as airflow limitation, are poor markers of relevant patient outcomes, largely because they do not reflect the multi-system nature of the disease. Therefore the identification. understanding and assessment of a" relevant co-morbidities in COPO are needed to better characterise the full clinical spectrum of the disease. Cognitive impairment is one such proposed co-morbidity with an emerging clinical relevance. Despite this, the understanding of cognitive problems and brain pathology in COPO remains incomplete. It is reasonable to regard patients with COPO to be at increased risk of neuronal " Injury, either through factors related to COPO such as hypoxaemia and airflow obstruction, or as a result of co-morbidities which adversely affect the brain such as vascular disease and diabetes. In this thesis, objective measures of neuropsychological function are made in a well-characterised cohort of COPO I patients during acute exacerbation and stable disease. The influence of disease • severity and co-morbidity are explored and compared with neuropsychological performance of local healthy controls. Brain pathology is assessed using novel magnetic resonance imaging techniques including diffusion tensor imaging (OTI) and 3-- 11 - Doctor of Philosophy (PhD) Thesis James W Dodd 2012 resting state functional MR imaging (rfMRI) which provide sensitive measures of white matter microstructure and grey functional activation respectively. The main findings suggest significant, unrecognised and acquired cognitive dysfunction in COPD, particularly in patients hospitalised with acute exacerbation. In addition there is evidence of reduction in white matter integrity throughout the brain and widespread disturbance in functional activation of grey matter independent of smoking and cerebrovascular co-morbiditv, which may contribute to cognitive dysfunction. The mechanisms remain unclear, but may include cerebral small vessel disease due to COPD.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available