Prognostic implications of cognitive impairment in COPD have previously been studied.Worse performance on neuropsychological tests is associated with higher COPD patientmortality.64,110 This finding may be explained bytwo main hypotheses: firstly, COPD patients with worse cognitive performance mightbe at a more advanced stage of the disease, presenting severe hypoxia which areassociated to lower survival rates; secondly these patients may have poor adherencenot only to inhaler medication techniques, as stated above, but also to oral andother co-morbidity drugs such as insulin pens. The gene discussed is INS; the disease is chronic obstructive pulmonary disease.