Cognitive Impairment, Depression, Anxiety, and Health-Related Quality of Life in Fibrotic ILD: A Cross-Sectional Study

Background Comorbidities such as systemic hypertension, coronary artery disease, and pulmonary hypertension are common in interstitial lung diseases and may significantly influence treatment selection, treatment outcomes, and health-related quality of life(HRQL). While a limited number of studies have investigated cognitive impairment(CI) as a comorbidity in patients with idiopathic pulmonary fibrosis(IPF), data regarding cognitive impairment in hypersensitivity pneumonitis(HP) are lacking. We aimed to evaluate CI in a cohort of patients with Fibrotic interstitial lung disease and investigate associated factors, including depression/anxiety and their effects on HRQL. Methods Ninety-four patients with F-ILD were included to the study and cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale (HADS). HRQL was evaluated using the Short Form-36 (SF-36). Results Of the 94 patients included, 61 (64.9%) were male, with a mean age of 63.6 ± 10.6 years, and 62.8% had a history of smoking. The cohort included 38 patients (40.4%) with IPF and 43 (45.7%) with fibrotic HP. The mean FVC% predicted and DLCO% were 72.2 ± 18.6% and 55.7 ± 20.7%, respectively, and mean 6-minute walk test (6MWT) distance was 350 ± 111 m. The mean MMSE and MoCA scores were 22.3 ± 5.5 and 18.9 ± 5.7, both below established cutoff values. CI was identified in 51.1% of patients using MMSE and in 66.0% using MoCA. MMSE-defined CI was more frequent in females, nonsmokers, patients with higher BMI, and those with anxiety, and was associated with lower physical functioning scores on SF-36. When CI was defined by MoCA, only a shorter 6MWT distance was related to CI. No significant correlations were found between age or FVC and cognitive scores, whereas BMI, DLCO%, and 6MWT distance showed weak correlations with cognitive performance. Conclusion In conclusion, CI was observed in more than half of patients with F-ILD and was associated with functional limitations, anxiety, and impaired HRQL . Awareness of CI in this patient population is essential for healthcare professionals, as it may facilitate appropriate assessment, individualized patient-centered approaches, and the implementation of supportive care strategies .