Structural brain changes in patients with chronic obstructive pulmonary disease (COPD)

Patients with COPD suffer from dyspnea, but little is known about brain pathology related to dyspnea in these patients. To test for regional gray matter volume (GMV) differences, 30 stable outpatients with moderate-to-severe COPD were compared with 30 gender- and age-matched healthy control subjects. T1-weighted structural brain images were acquired with magnetic resonance imaging and analyzed using voxel-based morphometry. A two-sample t-test between patients and controls included smoker status as covariate. Compared to healthy controls, patients with COPD showed decreased GMV in the posterior cingulate cortex (PCC; whole brain family-wise error corrected (FWE) P < .05), the posterior mid-cingulate cortex (pMCC; region of interest FWE P < .05), and the rostral anterior cingulate cortex (rACC; region of interest FWE P < .05). These regions are involved in nociception and emotional processing (Vogt, 2005). Comparable GMV reductions in PCC, pMCC, and rACC have been reported in patients suffering from chronic pain. Only in patients with COPD, partial correlation revealed that peak voxel GMV in the rACC was negatively correlated with ratings of fear of dyspnea (r = -.529, p < . 01) and fear of physical activity (r = -.456, p < .05). The present results demonstrate reduced gray matter volume in patients with COPD which were partly related to the affective response to dyspnea and activity and might be caused by constant experience of dyspnea. These structural changes were found in brain regions that are comparable to those observed in patients suffering from other unpleasant bodily sensations.