Meta-analysis of the relationship between chronic obstructive pulmonary disease and the risk of dementia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

BI Qi , HAN Xuemei , SHAN Xinyue , LIAN Cong ,  ZHAO Chunshan

Beihua University, Jilin, Jilin 132013, P. R. China;

Corresponding?author：

ZHAO Chunshan, Email: forchunshan@163.com

Keywords：

Chronic obstructive pulmonary disease; dementia; meta-analysis; cohort study

DOI：

10.7507/1671-6205.202507111

Video：

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Objective To explore the relationship between chronic obstructive pulmonary disease (COPD) and the risk of dementia. Methods Computerized searches were conducted in PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang Data Knowledge Service Platform, and China Biomedical Literature Database. Studies on cohort research on COPD and the risk of dementia were collected, with the search period ranging from the establishment of the databases to April 2025. Literature screening, data extraction, and literature quality evaluation were independently conducted by two researchers. Meta-analysis was performed using Stata 18.0 software. Results A total of 9 studies were included, involving 8,475,339 subjects. The meta-analysis results showed that compared with non-COPD populations, the risk of dementia in COPD populations increased by 23% (HR=1.23, 95%CI 1.14-1.33, P<0.001). The subgroup analysis results indicated that the risk of dementia in COPD patients aged 65 years or younger increased by 61% (HR=1.61, 95%CI 1.32-1.98, P<0.001), and the risk increased by 22% in COPD patients older than 65 years (HR=1.22, 95%CI 1.07-1.39, P<0.001); the risk of dementia in female COPD patients increased by 34% (HR=1.34, 95%CI 1.31-1.37, P<0.001), and in male COPD patients it increased by 31% (HR=1.31, 95%CI 1.28-1.33, P<0.001); the risk of dementia in COPD patients in the European and American regions increased by 32% (HR=1.32, 95%CI 1.30-1.34, P<0.001), and in the Asian region it increased by 20% (HR=1.20, 95%CI 1.06-1.37, P<0.05). In terms of the type of dementia, COPD increased the risk of vascular dementia (HR=1.64, 95%CI 1.26-2.13, P<0.001), but did not increase the risk of Alzheimer’s disease (HR=0.95, 95%CI 0.58-1.55, P>0.05). Conclusions COPD increases the risk of dementia. The risk increase is more significant in patients aged 65 years or younger, and COPD patients are more likely to have vascular dementia rather than Alzheimer’s disease.

Citation： BI Qi, HAN Xuemei, SHAN Xinyue, LIAN Cong, ZHAO Chunshan. Meta-analysis of the relationship between chronic obstructive pulmonary disease and the risk of dementia. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(1): 37-45. doi: 10.7507/1671-6205.202507111 Copy

1.	王鳳燕, 張冬瑩, 梁振宇, 等. 面向全科醫生的《慢性阻塞性肺疾病診治指南(2021年修訂版)》解讀. 中國全科醫學, 2021, 24(29): 3660-3663,3677.
2.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組, 中國醫師協會呼吸醫師分會慢性阻塞性肺疾病工作委員會. 慢性阻塞性肺疾病診治指南(2021年修訂版). 中華結核和呼吸雜志, 2021, 44(3): 170-205. DOI: 10.3760/cma.j.cn112147- 20210109-00031.
3.	Wang Z, Lin J, Liang L, et al. Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021. RespRes, 2025, 26(1): 2.
4.	Yin P, Wang H, Vos T, et al. A subnational analysis of mortality and prevalence of COPD in China from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Chest, 2016, 150(6): 1269-1280.
5.	Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
6.	He M, Liu Y, Guan Z, et al. Neuroimaging insights into lung disease related brain changes: from structure to function. Front Aging Neurosci, 2025, 17: 1550319.
7.	Puteikis K, Mameni?kien? R, Jurevi?ien? E. Neurological and psychiatric comorbidities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2021, 16: 553-562.
8.	Han KI, Yeo Y, Jo HJ, et al. Abnormal brain functional connectivity in patients with chronic obstructive pulmonary disease and correlations with clinical and cognitive parameters. Int J Chron Obstruct Pulmon Dis, 2025, 20: 971-985.
9.	Siegelaar A, Mobach MP, Janus S, et al. The physical environment and the quality of life and behavior in people with dementia: a systematic meta-review. S age Open Aging, 2025, 11: 30495334251345092.
10.	Lutsey PL, Chen N, Mirabelli MC, et al. Impaired lung function, lung disease, and risk of incident dementia. Am J Respir Crit Care Med, 2019, 199(11): 1385-1396.
11.	Kim HC. Risk of dementia in patients with age-related medical conditions: a retrospective cohort study. Psychogeriatrics, 2025, 25(1): e13222. doi: 10.1111/psyg.13222. Epub 2024 Nov 25.
12.	Rusanen M, Ngandu T, Laatikainen T, et al. Chronic obstructive pulmonary disease and asthma and the risk of mild cognitive impairment and dementia: a population based CAIDE study. Curr Alzheimer Res, 2013, 10(5): 549-555.
13.	Xiao T, Wijnant SRA, Licher S, et al. Lung function impairment and the risk of incident dementia: the Rotterdam study. J Alzheimers Dis, 2021, 82(2): 621-630.
14.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
15.	Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
16.	Smith C, Hiyoshi A, Hasselgren M, et al. The increased burden of morbidity over the life-course among patients with COPD: a register-based cohort study in Sweden. Int J Chron Obstruct Pulmon Dis, 2024, 19: 1375-1389.
17.	Xie F, Xie L. COPD and the risk of mild cognitive impairment and dementia: a cohort study based on the Chinese Longitudinal Health Longevity Survey. Int J Chron Obstruct Pulmon Dis, 2019, 14: 403-408.
18.	Fan YC, Lin SF, Chou CC, et al. Developmental trajectories and predictors of incident dementia among elderly taiwanese people: a 14-year longitudinal study. Int J Environ Res Public Health, 2023, 20(4): 3065.
19.	Shang X, Zhu Z, Zhang X, et al. Association of a wide range of chronic diseases and apolipoprotein E4 genotype with subsequent risk of dementia in community-dwelling adults: a retrospective cohort study. EClinicalMedicine, 2022, 45: 101335.
20.	Liao WC, Lin CL, Chang SN, et al. The association between chronic obstructive pulmonary disease and dementia: a population-based retrospective cohort study. Eur J Neurol, 2015, 22(2): 334-340. doi: 10.1111/ene.12573. Epub 2014 Oct 9.
21.	Choi JY, Rhee CK. Diagnosis and treatment of early chronic obstructive lung disease (COPD). J Clin Med, 2020, 9(11): 3426.
22.	Yoon S, Kim JM, Kang HJ, et al. Associations of pulmonary function with dementia and depression in an older Korean population. Psychiatry Investig, 2015, 12: 443-450.
23.	Burtscher J, Mallet RT, Burtscher M, et al. Hypoxia and brain aging: neurodegeneration or neuroprotection?. Ageing Res Rev, 2021, 68: 101343.
24.	Wang J, Xu W, Dove A, et al. Influence of lung function on macro- and micro-structural brain changes in mid- and late-life. Int J Surg, 2025, 111(3): 2467-2477.
25.	Ma YH, Shen LX, Li YZ, et al. Lung function and risk of incident dementia: a prospective cohort study of 431, 834 individuals. Brain Behav Immun, 2023, 109: 321-330.
26.	Fang C, Li A, Li Y. COPD, PRISm and lung function reduction affect the brain cortical structure: a Mendelian randomization study. BMC Pulm Med, 2024, 24(1): 341.
27.	Akhter F, Persaud A, Zaokari Y, et al. Vascular dementia and underlying sex differences. Front Aging Neurosci, 2021, 13: 720715.
28.	Sochocka M, Karska J, Pszczo?owska M, et al. Cognitive decline in early and premature menopause. Int J Mol Sci, 2023, 24(7): 6566.
29.	Huque H, Eramudugolla R, Chidiac B, et al. Could country-level factors explain sex differences in dementia incidence and prevalence? A systematic review and meta-analysis. J Alzheimers Dis, 2023, 91(4): 1231-1241.
30.	Li X, Feng X, Sun X, et al. Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990-2019. Front Aging Neurosci, 2022, 14: 937486.
31.	Huang Y, Li Y, Pan H, et al. Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide. J Glob Health, 2023, 13: 04160.
32.	李春陽, 王佳佳, 衛夢雨, 等. 慢性阻塞性肺疾病急性加重期患者報告結局測評工具研究現狀. 中國全科醫學, 2024, 27(31): 3896-3904.
33.	李宗姍, 魏麗麗, 桂雅星, 等. 認知功能評估量表研發與應用進展. 中國現代神經疾病雜志, 2021, 21(11): 927-933.

1. 王鳳燕, 張冬瑩, 梁振宇, 等. 面向全科醫生的《慢性阻塞性肺疾病診治指南(2021年修訂版)》解讀. 中國全科醫學, 2021, 24(29): 3660-3663,3677.
2. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組, 中國醫師協會呼吸醫師分會慢性阻塞性肺疾病工作委員會. 慢性阻塞性肺疾病診治指南(2021年修訂版). 中華結核和呼吸雜志, 2021, 44(3): 170-205. DOI: 10.3760/cma.j.cn112147- 20210109-00031.
3. Wang Z, Lin J, Liang L, et al. Global, regional, and national burden of chronic obstructive pulmonary disease and its attributable risk factors from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021. RespRes, 2025, 26(1): 2.
4. Yin P, Wang H, Vos T, et al. A subnational analysis of mortality and prevalence of COPD in China from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Chest, 2016, 150(6): 1269-1280.
5. Wang C, Xu J, Yang L, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study. Lancet, 2018, 391(10131): 1706-1717.
6. He M, Liu Y, Guan Z, et al. Neuroimaging insights into lung disease related brain changes: from structure to function. Front Aging Neurosci, 2025, 17: 1550319.
7. Puteikis K, Mameni?kien? R, Jurevi?ien? E. Neurological and psychiatric comorbidities in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2021, 16: 553-562.
8. Han KI, Yeo Y, Jo HJ, et al. Abnormal brain functional connectivity in patients with chronic obstructive pulmonary disease and correlations with clinical and cognitive parameters. Int J Chron Obstruct Pulmon Dis, 2025, 20: 971-985.
9. Siegelaar A, Mobach MP, Janus S, et al. The physical environment and the quality of life and behavior in people with dementia: a systematic meta-review. S age Open Aging, 2025, 11: 30495334251345092.
10. Lutsey PL, Chen N, Mirabelli MC, et al. Impaired lung function, lung disease, and risk of incident dementia. Am J Respir Crit Care Med, 2019, 199(11): 1385-1396.
11. Kim HC. Risk of dementia in patients with age-related medical conditions: a retrospective cohort study. Psychogeriatrics, 2025, 25(1): e13222. doi: 10.1111/psyg.13222. Epub 2024 Nov 25.
12. Rusanen M, Ngandu T, Laatikainen T, et al. Chronic obstructive pulmonary disease and asthma and the risk of mild cognitive impairment and dementia: a population based CAIDE study. Curr Alzheimer Res, 2013, 10(5): 549-555.
13. Xiao T, Wijnant SRA, Licher S, et al. Lung function impairment and the risk of incident dementia: the Rotterdam study. J Alzheimers Dis, 2021, 82(2): 621-630.
14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
15. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997, 315(7109): 629-634.
16. Smith C, Hiyoshi A, Hasselgren M, et al. The increased burden of morbidity over the life-course among patients with COPD: a register-based cohort study in Sweden. Int J Chron Obstruct Pulmon Dis, 2024, 19: 1375-1389.
17. Xie F, Xie L. COPD and the risk of mild cognitive impairment and dementia: a cohort study based on the Chinese Longitudinal Health Longevity Survey. Int J Chron Obstruct Pulmon Dis, 2019, 14: 403-408.
18. Fan YC, Lin SF, Chou CC, et al. Developmental trajectories and predictors of incident dementia among elderly taiwanese people: a 14-year longitudinal study. Int J Environ Res Public Health, 2023, 20(4): 3065.
19. Shang X, Zhu Z, Zhang X, et al. Association of a wide range of chronic diseases and apolipoprotein E4 genotype with subsequent risk of dementia in community-dwelling adults: a retrospective cohort study. EClinicalMedicine, 2022, 45: 101335.
20. Liao WC, Lin CL, Chang SN, et al. The association between chronic obstructive pulmonary disease and dementia: a population-based retrospective cohort study. Eur J Neurol, 2015, 22(2): 334-340. doi: 10.1111/ene.12573. Epub 2014 Oct 9.
21. Choi JY, Rhee CK. Diagnosis and treatment of early chronic obstructive lung disease (COPD). J Clin Med, 2020, 9(11): 3426.
22. Yoon S, Kim JM, Kang HJ, et al. Associations of pulmonary function with dementia and depression in an older Korean population. Psychiatry Investig, 2015, 12: 443-450.
23. Burtscher J, Mallet RT, Burtscher M, et al. Hypoxia and brain aging: neurodegeneration or neuroprotection?. Ageing Res Rev, 2021, 68: 101343.
24. Wang J, Xu W, Dove A, et al. Influence of lung function on macro- and micro-structural brain changes in mid- and late-life. Int J Surg, 2025, 111(3): 2467-2477.
25. Ma YH, Shen LX, Li YZ, et al. Lung function and risk of incident dementia: a prospective cohort study of 431, 834 individuals. Brain Behav Immun, 2023, 109: 321-330.
26. Fang C, Li A, Li Y. COPD, PRISm and lung function reduction affect the brain cortical structure: a Mendelian randomization study. BMC Pulm Med, 2024, 24(1): 341.
27. Akhter F, Persaud A, Zaokari Y, et al. Vascular dementia and underlying sex differences. Front Aging Neurosci, 2021, 13: 720715.
28. Sochocka M, Karska J, Pszczo?owska M, et al. Cognitive decline in early and premature menopause. Int J Mol Sci, 2023, 24(7): 6566.
29. Huque H, Eramudugolla R, Chidiac B, et al. Could country-level factors explain sex differences in dementia incidence and prevalence? A systematic review and meta-analysis. J Alzheimers Dis, 2023, 91(4): 1231-1241.
30. Li X, Feng X, Sun X, et al. Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990-2019. Front Aging Neurosci, 2022, 14: 937486.
31. Huang Y, Li Y, Pan H, et al. Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide. J Glob Health, 2023, 13: 04160.
32. 李春陽, 王佳佳, 衛夢雨, 等. 慢性阻塞性肺疾病急性加重期患者報告結局測評工具研究現狀. 中國全科醫學, 2024, 27(31): 3896-3904.
33. 李宗姍, 魏麗麗, 桂雅星, 等. 認知功能評估量表研發與應用進展. 中國現代神經疾病雜志, 2021, 21(11): 927-933.

Chinese Journal of Respiratory and Critical Care Medicine

Meta-analysis of the relationship between chronic obstructive pulmonary disease and the risk of dementia

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