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Factors associated with cognitive impairment in COPD patients Cognitive impairment in COPD arises from a complex interplay of multiple factors, including inflammation, hypoxemia, hypercapnia, acute exacerbations, comorbidities (obstructive sleep apnoea, cerebral microbleeds, anxiety, and depression), and smoking ( Inflammation Chronic pulmonary inflammation in COPD disrupts the balance between immune system-mediated damage and repair mechanisms ( Hypoxemia and hypercapnia Alveolar hypoventilation in COPD frequently results in hypoxemia and hypercapnia, both of which contribute to cognitive decline ( Hypercapnia, often severe in advanced COPD (as indicated by higher GOLD stages), exerts deleterious effects on the central nervous system

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