Impact of COPD and anemia on motor and cognitive performance in the general older population: results from the English longitudinal study of ageing

Respir Res. 2020 Feb 3;21(1):40. doi: 10.1186/s12931-020-1305-6.


Background: Cognitive and motor-performance decline with age and the process is accelerated by decline in general health. In this study, we aimed to estimate the effects of COPD and HB levels on cognitive and motor performance in the general older population and assess potential interaction.

Methods: The English Longitudinal Study of Aging is a population-based cohort study including measurements of lung-function and HB levels together with cognitive and motor performance testing. Data were collected from 5709 participants including three measurement time over eight years. COPD was defined using lung-function-parameters and clinical symptoms. HB was assessed continuously and low HB was defined using clinical anemia cutoffs. Linear mixed-effects regression models were used to quantify the associations of COPD and HB with outcome measures, both individually and in combination.

Results: Participants with both low HB and COPD demonstrated worse motor performance compared to individuals with only one exposure, resulting in up to 1 s (95%CI, 0.04-1.8) longer time needed to complete the five times sit to stand task than what would be expected based on purely additive effects. Additionally in individuals with COPD, the time to complete the motor-performance task per unit decrease in continuous HB levels was longer than in participants without COPD after full adjustment for confounding (up to 1.38 s/unit HB level, 95% CI: 0.65-2.11).

Conclusion: In persons with COPD low HB levels may contribute to low motor-performance in a supra additive fashion. Further studies should re-evaluate whether earlier treatment of lower HB in these individuals might be beneficial.

Keywords: Anemia; Chronic obstructive pulmonary disease; Cognitive function; Interaction; Motor function.

MeSH terms

  • Aged
  • Aging / blood*
  • Aging / psychology
  • Anemia / blood*
  • Anemia / epidemiology
  • Anemia / psychology
  • Cognition / physiology*
  • Cohort Studies
  • England / epidemiology
  • Female
  • Forced Expiratory Volume / physiology
  • Hemoglobins / metabolism
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Population Surveillance* / methods
  • Prospective Studies
  • Psychomotor Performance / physiology*
  • Pulmonary Disease, Chronic Obstructive / blood*
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Pulmonary Disease, Chronic Obstructive / psychology


  • Hemoglobins