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. Design The study design was a randomized, repeated measures, double-blind, double-dummy, placebocontrolled comparison of theophylline and ipratropium treatments. Setting Ambulatory patients were tested at the Clinical Trials Center of the University of California, San Diego, Medical Center. Patients Ambulatory patients with chronic obstructive pulmonary disease aged 65 years or more with FEV 1 , 1 /FVC 1 Interventions Patients received either theophylline or ipratropium for 2 weeks, followed by a 1-week placebo control period, then a 2-week treatment period of the alternative drug therapy. A standard therapy of albuterol MDI, 2 puffs (180 μg) qid was given throughout the study. Measurements The main 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, pulmonary 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 detect a harmful effect of treatment with either theophylline or ipratropium on the performance of elderly patients with chronic obstructive pulmonary disease on a battery of psychometric tests, suggesting that significant cognitive impairment in the elderly is not commonly associated with treatment with either theophylline or ipratropium.