Introduction
Chronic obstructive pulmonary disease (COPD) is one of the most common diseases in old age, which has adverse consequences on cognitive functions. Examining the effects of age as a risk factor and cognitive reserve as a protective factor can help develop preventive strategies for people at risk of COPD to manage the symptoms of cognitive impairment in old age. Therefore, the present study aims to investigate the main effects of aging and cognitive reserve on reducing the speed of information processing and visual-spatial active memory and increasing cognitive failures in patients with COPD.

Methods
This is a descriptive cross-sectional study that was conducted in Shahid Motahari Specialized Clinic, Shahid Rajaei Hospital, and Imam Reza Hospital in Shiraz, Iran. Participants were 208 patients (104 middle-aged and 104 elderly) with COPD. The data collection tools were a) The cognitive reserve index, with 20 and three sections: Education, working activities, and leisure time. It has a total score of 100, with higher scores indicating higher cognitive reserve ability [31, 32]; b) The cognitive failures questionnaire with 25 items rated on a 5-point Likert scale from 0 (never) to 4 (always). The total score ranges from 0 to 100, with higher scores indicating higher cognitive failure [24]; c) The Corsi block-tapping test: The subject is asked to remember the sequence of the blocks and then repeat it. The test starts with a sequence of 2 blocks and gradually increases up to a sequence of 9 blocks and the longest sequence remembered by the subject is recorded [35]; d) The symbol digit modalities test: It contains a key with numbers 1 to 9, each number corresponds to a geometric symbol, and the participants have 90 seconds to pair specific numbers with given geometric figures [29] and their score is calculated based on the number of correct answers [30]. The main and interaction effects of age (middle-aged vs. elderly) and cognitive reserve (low-moderate vs moderate-high cognitive reserve) on the study variables were assessed using two-way multivariate analysis of variance in SPSS software, version 27.

Results
In the current study, among 104 middle-aged people with COPD, there were 56 males (54%) and 48 females (46%) with an mean age of 58.79±3.66 years. Among 104 elderly people with COPD, there were 59 males (57%) and 45 females (43%) with a mean age of 69.53±3.03 years. The results of two-way multivariate analysis of variance showed that the main effect of age on information processing speed (F(1, 204)=6.10, P=0.014, η2=0.029), visual-spatial working memory (F (1, 204)=7.16; P=0.008, η2=0.034), and cognitive failure (F(1, 204)=52.65, P<0.001, η2=0.205) was significant in COPD patients. With increasing age, information processing speed and visuospatial active memory decrease in the elderly patients compared to middle-aged patients, while the rate of cognitive failures in the elderly patients is significantly higher than that of middle-aged patients. The results also showed that the main effect of cognitive reserve on information processing speed (F(1, 204)=21.54, P<0.001, η2=0.095), and cognitive failure (F(1, 204)=4.14, P=0.043, η2=0.020) was significant in COPD patients, but it had no significant effect on visual-spatial working memory (F(1, 204)=3.62; P=0.058, η2=0.017). Patients with moderate-high cognitive reserve, compared to patients with low-moderate cognitive reserve, experience faster information processing and less cognitive failures.
Furthermore, the results showed that the interaction effect of age and cognitive reserve was significant only on cognitive failure (F(1, 204)=4.39, P=0.037, η2=0.021). Their effect on information processing speed (F(1, 204)=0.749, P=0.381, η2=0.004) and visual-spatial working memory (F(1, 204)=2.51; P=0.115, η2=0.012) was not significant. Therefore, it can be stated that with increasing age, cognitive reserve may not have a significant effect on improving information processing speed and visuospatial active memory in the elderly with COPD, but it is able to reduce the possibility of cognitive failures.

Conclusion
The results of the present study indicated that although the speed of information processing may decrease with aging, cognitive reserve can partially compensate for this deficiency in old age. Also, the results showed that aging is associated with a decrease in visual-spatial active memory, but cognitive reserve had no significant effect on visual-spatial active memory. This finding suggests that COPD may play a major role in visual-spatial working memory performance in patients. In addition, the results of our study showed that although aging can increase cognitive failures, cognitive reserve can play a protective role against cognitive failures in elderly patients with COPD. According to the results of the present study, the evaluation of cognitive reserve and a better understanding of the prognosis of age-related cognitive failures can help promote more targeted cognitive rehabilitation programs to maintain or improve the cognitive abilities of middle-aged and elderly people with COPD.

Ethical Considerations

Compliance with ethical guidelines
The present study has been approved by the Research Ethics Committee of the Psychology Department at Shahid Bahonar University of Kerman (Code: E.A.01.08.25.01).

Funding
This article is extracted from the PhD dissertation of Fateme Moradi, approved by Department of Psychology, Faculty of Literature and Humanities, Shahid Bahonar University of Kerman.

Authors' contributions
All authors equally contributed to preparing this paper.

Conflicts of interest
The authors declared no conflicts of interest.


 

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