Abstract

Cognitive impairment is a common systemic manifestation of chronic obstructive pulmonary disease (COPD) and is associated with higher levels of functional dependence [1], poorer medical adherence [2] and greater mortality [3]. However, its neurobiological causes remain unclear.We have previously reported greater volumes of hyperintense white matter lesions (WML) and widespread white matter (WM) tissue microstructural changes (fromDiffusion Tensor Imaging, DTI) in people with COPD [4]. These and findings from other studies, such as hypoperfusion [5][6], hippocampal atrophy [7], localised grey matter (GM) loss [8][9], and presence of cerebralmicrobleeds [10] are consistent with a vascular pathophysiology. However, several studies, including our own, are confounded by large group differences in smoking history. The Novel VascularManifestations of COPD (NoVasC) study was designed to address this limitation through direct comparison of COPD patients and smoking controls.