EFFECTS OF THEOPHYLLINE AND IPRATROPIUM ON COGNITION IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Objectives: To determine whether chronic therapy with theophylline or ipratropium has an adverse effect on cognition and psychomotor skills in geriatric patients with chronic obstructive pulmonary disease. Desi gn: The study design was a randomized, repeated measures, double-blind , double-dummy, placebo-controlled comparison of theophylline and ipra tropium treatments. Setting: Ambulatory patients were tested at the Cl inical Trials Center of the University of California, San Diego, Medic al Center. Patients: Ambulatory patients with chronic obstructive pulm onary disease aged 65 years or more with FEV(1), <60% predicted, FEV(1 )/FVC <70%, and post bronchodilator FEV(1) <70%. Interventions: Patien ts received either theophylline or ipratropium for 2 weeks, followed b y a 1-week placebo control period, then a 2-week treatment period of t he alternative drug therapy. A standard therapy of albuterol MDI, 2 pu ffs (180 mu g) qid was given throughout the study. Measurements: The m ain response level was an 11-part battery of psychometric tests. Tests were administered at the end of each treatment period and at the end of the washout period. Covariates were sequence of treatment, pulmonar y function tests, age, and baseline psychometric test scores. Results: There was no difference in performance scores on the cognitive tests among the three treatment periods. Conclusions: We were unable to dete ct a harmful effect of treatment with either theophylline or ipratropi um on the performance of elderly patients with chronic obstructive pul monary disease on a battery of psychometric tests, suggesting that sig nificant cognitive impairment in the elderly is not commonly associate d with treatment with either theophylline or ipratropium.