The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: A systematic review

Factors affecting 12-month unplanned readmissions for chronic obstructive pulmonary disease patients: the effect of mental disorders in an Australian cohort

BACKGROUND

Many individuals with chronic obstructive pulmonary disease (COPD) experience frequent hospitalization and readmissions, which is burdensome on the health system. This study aims to investigate factors associated with unplanned readmissions and mortality following a COPD-related hospitalization over a 12-month period in Australia, focusing on mental disorders and accounting for the acute phase of the COVID-19 pandemic.

METHODS

A retrospective cohort study using linked hospitalization and mortality records identified individuals aged ≥40 years who had at least one hospital admission with a principal diagnosis of COPD between 2014 and 2020 in New South Wales, Australia. A semi-competing risk analysis was conducted to examine factors associated with unplanned readmission and mortality.

RESULTS

Adults with a mental disorder diagnosis, specifically anxiety, had a higher risk of 12-month unplanned readmission. Individuals with anxiety and dementia also had a higher risk of mortality pre- and post-unplanned readmission. Individuals who were admitted during the acute phase of the COVID-19 pandemic period had lower risk of unplanned readmission, but higher risk of mortality without unplanned readmission.

CONCLUSION

Interventions aimed at reducing admissions should consider adults living with mental disorders such as anxiety or dementia to improve healthcare delivery and health outcomes for individuals living with COPD.

Evaluation of Event-Related Potentials in Somatic Diseases - Systematic Review

Many somatic illnesses (e.g. hypertension, diabetes, pulmonary and cardiac diseases, hepatitis C, kidney and heart failure, HIV infection, Sjogren's disease) may impact central nervous system functions resulting in emotional, sensory, cognitive or even personality impairments. Event-related potential (ERP) methodology allows for monitoring neurocognitive processes and thus can provide a valuable window into these cognitive processes that are influenced, or brought about, by somatic disorders. The current review aims to present published studies on the relationships between somatic illness and brain function as assessed with ERP methodology, with the goal to discuss where this field of study is right now and suggest future directions.

Exercise training influence on cognitive capacity and mental health within chronic obstructive pulmonary disease - A pilot study

Objective

Although pulmonary rehabilitation and regular exercise have improved negative emotions and cognitive capacity within cases of chronic obstructive pulmonary disease (COPD), influence by exercise training upon different cognitive and memory functions in COPD is still controversial. This investigation aimed to assess whether cognitive performance and mental health are affected by the benefits of exercise training within cases of COPD.

Materials and Methods

This pilot investigation included thirty-three patients with Global Initiative for Chronic Obstructive Lung Disease stage ≥B. Based on the subjects' rights, all included patients could choose to join either the exercise group or the control group, according to their free will. Twelve patients were assigned to receive exercise treatment over a 2-month period, while the remaining 16 patients were assigned to the control group. Cognitive capacity outcomes were measured using the Wechsler Memory Scale-III Word List Test, Stroop task, and psychomotor vigilance task (PVT). Mood states were assessed through the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Results

Most cases demonstrated major improvement for BDI and BAI scorings post-60-day therapy. During PVT, the omission rate decreased, while the hit rate increased, indicating an improvement in attention performance. Furthermore, this investigation found a significant increase in immediate verbal and recognition memory for word-list test. However, no major performance shifts were found on Stroop analysis.

Conclusion

This investigation demonstrated that a 2-month exercise training program resulted in significant improvement in negative emotions, immediate memory, recognition memory, and attention.

Cognitive Function in Patients With Mild Idiopathic Pulmonary Fibrosis: A Case-Control Pilot Study

This case-control study examined cognitive function in patients with mild idiopathic pulmonary fibrosis (IPF), in comparison with controls or moderate-to-severe IPF. Ten mild IPF, 10 moderate-to-severe IPF, and 16 controls were enrolled, and performance on seven different cognitive function tests was compared in each group. IPF showed decreased cognitive function compared to controls in verbal memory, cognitive flexibility and information processing speed. As the scores were lower even in mild IPF, this study suggests that cognitive function declines early in the disease process of IPF. Thus, occupational therapy for IPF should require an assessment of cognitive function and assistance appropriate to the client's function.

Roles of Omega-3 Polyunsaturated Fatty Acids in Managing Cognitive Impairment in Chronic Obstructive Pulmonary Disease: A Review

Chronic obstructive pulmonary disease (COPD) contributes significantly to the death of people worldwide, especially the elderly. An essential feature of COPD is pulmonary inflammation, which results from long-term exposure to noxious substances from cigarette smoking and other environmental pollutants. Pulmonary inflammatory mediators spill over to the blood, leading to systemic inflammation, which is believed to play a significant role in the onset of a host of comorbidities associated with COPD. A substantial comorbidity of concern in COPD patients that is often overlooked in COPD management is cognitive impairment. The exact pathophysiology of cognitive impairment in COPD patients remains a mystery; however, hypoxia, oxidative stress, systemic inflammation, and cerebral manifestations of these conditions are believed to play crucial roles. Furthermore, the use of medications to treat cognitive impairment symptomatology in COPD patients has been reported to be associated with life-threatening adverse effects, hence the need for alternative medications with reduced side effects. In this Review, we aim to discuss the impact of cognitive impairment in COPD management and the potential mechanisms associated with increased risk of cognitive impairment in COPD patients. The promising roles of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in improving cognitive deficits in COPD patients are also discussed. Interestingly, ω-3 PUFAs can potentially enhance the cognitive impairment symptomatology associated with COPD because they can modulate inflammatory processes, activate the antioxidant defence system, and promote amyloid-beta clearance from the brain. Thus, clinical studies are crucial to assess the efficacy of ω-3 PUFAs in managing cognitive impairment in COPD patients.

Association between cognitive decline and activities of daily living decline in patients undergoing long-term oxygen therapy: a prospective observational pilot study

PURPOSE

Patients undergoing long-term oxygen therapy (LTOT) are predisposed to progressive cognitive decline; however, the association between cognitive decline progression and activities of daily living (ADL) decline has not been described. We aimed to describe the association between cognitive decline progression and ADL decline in patients undergoing LTOT.

MATERIALS AND METHODS

In this prospective observational pilot study, data were collected at baseline and 1-year following the ambulatory recruitment of patients in the Department of Respiratory Medicine at the National Hospital Organization Nishiniigata Chuo Hospital. We recruited 96 patients with chronic respiratory disease undergoing LTOT, and 55 patients who completed a 1-year follow-up were finally included.

RESULTS

Multivariate logistic regression analysis revealed that Montreal Cognitive Assessment score reduction (a measure of cognitive decline) was associated with Barthel index score reduction (a measure of ADL) at 1-year follow-up (odds ratio: 3.98; 95% confidence interval: 1.16 - 13.69; p = 0.02).

CONCLUSION

A progression of cognitive decline in patients undergoing LTOT may affect ADL decline. An early detection of cognitive decline in patients undergoing LTOT is essential for ADL maintenance in rehabilitation practice.IMPLICATIONS FOR REHABILITATIONPatients undergoing long-term oxygen therapy (LTOT) present with progressive cognitive decline.Cognitive decline progression is associated with a decline in activities of daily living in patients undergoing LTOT.A periodic cognitive assessment is important in rehabilitation practice for the early detection of progressive cognitive decline in patients undergoing LTOT.

Cognitive Interventions in Individuals With Chronic Respiratory Diseases: Protocol for a Systematic Review

BACKGROUND

Chronic respiratory diseases (CRDs) may cause reduced oxygen availability to organs and body tissues, leading to an increased risk for ischemic damage, which can result in brain tissue injury. This damage can lead to a myriad of neurological symptoms contributing to cognitive decline. Cognitive interventions may attenuate cognitive deficits in people with CRDs; however, the effects have not yet been systematically summarized in the literature.

OBJECTIVE

The purpose of this systematic review is to assess the effects of cognitive interventions (including cognitive behavioral therapy and transcranial brain stimulation) on cognitive function (primary outcome), HRQL, self-management, symptoms, physical activity, physical function, ability to complete activities of daily living (ADLs), hospital admissions, functional capacity, functional performance, psychological and social outcomes, exacerbations, healthcare utilization, and survival in individuals with CRDs.

METHODS

This review will be conducted in accordance with the Cochrane handbook for systematic reviews of interventions and reported following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Searches will be performed in MEDLINE, Embase, Emcare, PsycINFO, Scopus, and CINAHL. Articles will be included if they focus on the effects of cognitive interventions on adults with CRDs, are published in peer-reviewed journals, and are written in English, French, or Portuguese. Risk of bias will be evaluated with the Cochrane Risk of Bias 2 tool for randomized controlled trials, and the Risk of Bias in Non-randomized Studies of Interventions tool for nonrandomized studies. Meta-analyses will be performed if at least 2 studies provided sufficient data for a specific outcome. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) assessment will be used to evaluate the overall quality of the evidence.

RESULTS

This systematic review was initiated in November 2022 and registered with PROSPERO in February 2023, prior to title and abstract screening. Full-text screening of articles will be completed in June 2023. Data extraction and drafting of the manuscript will occur from July 2023 to August 2023, with expected publication in February 2024.

CONCLUSIONS

This systematic review will summarize the effects of cognitive interventions on cognitive function in people with CRDs. It will guide health care professionals in selecting evidence-based strategies to enhance cognitive well-being and overall health outcomes for individuals with CRDs. Additionally, it will identify research gaps and highlight areas for future exploration, supporting researchers in advancing knowledge in this field.

TRIAL REGISTRATION

PROSPERO CRD42023396234; https://tinyurl.com/mwjrfbxv.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/48235.

Alzheimer Disease and Related Cognitive Impairment in Older Adults: A Narrative Review of Screening, Prevention, and Management for Manual Therapy Providers

Objective

The aim of this narrative review was to review literature relevant to manual therapists about cognitive impairment, together with screening, potential treatment, and prevention modalities.

Methods

A literature search of AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index of Nursing and Allied Health Literature), PubMed, and MEDLINE was conducted with the search terms "cognitive decline," "cognitive impairment," "screening," and "prevention." We reviewed current screening practices, including functional exams, imaging, and laboratory testing. We reviewed current potential preventive measures and treatments being implemented in practice.

Results

We selected 49 resources for this narrative summary. The Montreal Cognitive Assessment and Mini-Mental State Exam are recommended screening tools. Imaging and laboratory testing are not recommended in screening for cognitive decline. Promotion of healthy, active living through physical and mental activities may assist with prevention of cognitive decline.

Conclusion

Cognitive decline affects a large proportion of the US population. Recognizing signs and symptoms of this condition starts with individuals, caretakers, family members, and health care providers. Health care providers should utilize the most appropriate screening tools to assess the presence of cognitive conditions.

Cognitive impairment according to Montreal Cognitive Assessment independently predicts the ability of chronic obstructive pulmonary disease patients to maintain proper inhaler technique

BACKGROUND

Maintaining correct inhaler technique is crucial in the management of chronic obstructive pulmonary disease (COPD). We aimed to investigate the inhaler technique in patients with COPD, to compare it immediately after and at 1 month after training, and to identify the predictors of incorrect inhaler use at 1 month after training.

METHODS

This prospective study was conducted at the COPD clinic of Siriraj Hospital (Bangkok, Thailand). Patients demonstrating improper inhaler use were trained face-to-face by pharmacists. Inhaler technique was re-assessed immediately after and at 1 month after training. The Montreal Cognitive Assessment (MoCA) score, pulmonary function tests, 6-min walk distance (6 MWD), modified Medical Research Council scale score, and COPD Assessment Test (CAT) score were evaluated.

RESULTS

Sixty-six patients with COPD who demonstrated at least one critical error during the use of any controller inhaler were enrolled. The mean age was 73.0 ± 9.0 years, and 75.8% patients had moderate/severe COPD. Immediately after training, all patients used dry powder inhalers correctly and 88.1% used pressurized metered-dose inhalers correctly. At 1 month, the number of patients demonstrating the correct technique decreased across all devices. Multivariable analysis revealed that MoCA score ≤ 16 was independently associated with a critical error at 1 month after training (adjusted odds ratio: 12.7, 95% confidence interval: 1.8-88.2, p = 0.010). At 1 month, CAT score (11.4 ± 8.9 vs. 8.4 ± 5.5, p = 0.018) and 6 MWD (351 ± 93 m vs. 372 ± 92 m, p = 0.009) had significantly improved in patients demonstrating the correct technique, and CAT score met the minimal clinically important difference.

CONCLUSIONS

Face-to-face training by pharmacists improved patient performance. However, the number of patients following proper technique had decreased at 1 month after training. Cognitive impairment (MoCA score ≤ 16) independently predicted the ability of COPD patients to maintain proper inhaler technique. Assessment of cognitive function combined with technical re-assessment and repeated training should improve COPD management.

Comorbid Cognitive Impairment in Chronic Obstructive Pulmonary Disease (COPD): Current Understanding, Risk Factors, Implications for Clinical Practice, and Suggested Interventions

Cognitive impairment is a common comorbidity in patients with COPD, significantly impacting health and clinical outcomes. Yet it remains under investigated and is largely overlooked. Although the exact cause of cognitive impairment in patients with COPD is still unclear, factors such as hypoxemia, vascular disease, smoking, exacerbation, and physical inactivity have been suggested. While international guidelines recommend identifying comorbidity in patients with COPD, such as cognitive impairment, cognitive assessment is not yet part of the routine assessment. Unidentified cognitive deficits in patients with COPD may have severe impacts on clinical management, resulting in an inability to maintain functional independence, poor self-management, and a greater dropout from pulmonary rehabilitation programs. There is a need to consider cognitive screening as a part of COPD assessment to promote early detection of cognitive impairment. Recognizing cognitive impairment early in the course of the illness allows the development of individualized interventions to meet patients' needs and improve clinical outcomes. Pulmonary rehabilitation should be tailored to cognitively impaired patients with COPD to maximize the benefits and minimize the incompletion rate.

The adjusted impact of different severities of acute exacerbations and medications on the risk of developing dementia in COPD patients

BACKGROUND

Although a relationship between chronic obstructive pulmonary disease (COPD) and dementia has been reported, the initial severity upon emergency department (ED) visits and the medications used have not been well evaluated as risk factors for increased dementia occurrence. We aimed to analyze the risks of dementia development over 5 years among patients with COPD compared to matched controls (primary) and the impact of different severities of acute exacerbations (AEs) of COPD and medications on the risk of dementia development among COPD patients (secondary).

METHOD

This study used the Taiwanese government deidentified health care database. We enrolled patients during the 10-year study period (January 1, 2000, to December 31, 2010), and each patient was followed up for 5 years. Once these patients received a diagnosis of dementia or died, they were no longer followed up. The study group included 51,318 patients who were diagnosed with COPD and 51,318 matched (in terms of age, sex, and the number of hospital visits) non-COPD patients from the remaining patients as the control group. Each patient was followed up for 5 years to analyze the risk of dementia with Cox regression analysis. Data on medications (antibiotics, bronchodilators, corticosteroids) and severity at the initial ED visit (ED treatment only, hospital admission, or ICU admission) were collected for both groups, as well as demographics and baseline comorbidities, which were considered confounding factors.

RESULTS

In the study and control groups, 1,025 (2.0%) and 423 (0.8%) patients suffered from dementia, respectively. The unadjusted HR for dementia was 2.51 (95% CI: 2.24-2.81) in the study group. Bronchodilator treatment was associated with the HRs, especially among those who received long-term (> 1 month) treatment (HR = 2.10, 95% CI: 1.91-2.45). Furthermore, among 3,451 AE of COPD patients who initially visited the ED, patients who required ICU admission (n = 164, 4.7%) had a higher risk of dementia occurrence (HR = 11.05, 95% CI: 7.77-15.71).

CONCLUSION

Bronchodilator administration might be associated with a decreased risk of dementia development. More importantly, patients who suffered AEs of COPD and initially visited the ED and required ICU admission had a higher risk of developing dementia.

Limitations in Activities of Daily Living among Older Adults with COPD, Asthma, or Asthma-COPD Overlap Residing in Spain

Activities of daily living (ADL) may be limited by the presence of chronic diseases, and limitations in ADL contribute to an increased risk of falling. In people with asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO), ADL may be affected owing to poor asthma control and COPD ventilatory limitations. The aim of this study was to establish the differing prevalence of limitations in ADL among older Spanish adults with chronic respiratory diseases (COPD, asthma, and ACO). Data from the Spanish National Health Survey were analyzed. The sample was composed of 944 older adults aged ≥65 years and with a positive diagnosis of COPD (n = 502), asthma (n = 241), or ACO (n = 201). Five basic activities of daily living (BADL) and seven instrumental activities of daily living (IADL) were studied. Frequency and percentages were used to describe sample characteristics and limitations of ADL. Significant differences were analyzed using chi-square tests. Results revealed a significant higher number of older adults with COPD (34.8%) and asthma (32.5%) without limitations in doing hard housework in comparison to ACO (17.8%). Regarding meal preparation, a higher percentage of asthmatics without difficulties (77.7%) and a lower percentage with many difficulties (2.6%) were observed in comparison to ACO (64.8%-10.2%). No differences were found in BADL, with approximately 80-90% without limitations. It seems that limitations in IADL vary according to the type of chronic pulmonary diseases, but further research is needed to clarify why differences were found only for preparing meals and hard housework. These findings should be considered in the design of interventions to promote ADL in older adults with respiratory disease.

The association between total cholesterol and cognitive impairment in chronic obstructive pulmonary disease patients

AIM

Chronic obstructive pulmonary disease (COPD) is primarily a respiratory system disorder associated with extrapulmonary conditions. Cognitive impairment (CoI) is very common among COPD patients This study sought to investigate the association between CoI and clinical parameters, inflammatory markers and lipid profiles in a COPD patient population.

METHODS

The study population included 111 stable COPD patients. COPD was diagnosed according to Global Initiative for Chronic Obstructive Lung Disease guideline. Total complete blood count test and biochemical measurements including lipid profile were performed. Afterwards, all patients underwent neuropsychological assessment including Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index and Montreal Cognitive Assessment (MoCA) tests.

RESULTS

The patients were categorized into two groups according to their MoCA test score: MoCA score ≤ 21 (CoI) (n = 69) and MoCA score > 21 (normal cognition) (n = 42). Total cholesterol (TC) levels were significantly lower in patients with CoI compared to patients with normal cognition. Inflammation related parameters including C-reactive protein were similar among groups. Multivariate logistic regression analysis yielded education, HADS score and TC (OR:1.02, 95% CI:1.00-1.04, p = 0.025) as independent predictors of MoCA score.

CONCLUSION

TC independently associates with CoI in COPD patients. There is comparable inflammatory status in COPD patients with CoI compared to COPD patients with normal cognition.

Preliminary study of assessing cognitive impairment in older patients with chronic obstructive pulmonary disease by using a cognitive functional assessment tool via a touchscreen personal computer

Background

Unique cognitive impairments related to chronic obstructive pulmonary diseases (COPD) have been increasingly reported. Considering the dementia risk and medication management, older patients with COPD should be evaluated for cognitive impairment. This study aimed to examine whether specific cognitive impairments related to COPD could be detected by an assessment tool using a touchscreen personal computer (PC) in older patients with COPD.

Methods

This study included 28 older male patients with COPD and 30 healthy older male individuals. A touchscreen PC-based cognitive assessment application called CogEvo was used to assess and compare the cognitive function according to five domains: spatial cognition, orientation, working memory, executive function, and attention.

Results

Analysis of variance showed an interaction effect on the indices of cognitive function based on five domains between the two groups, indicating differences in the characteristics of cognitive function in such groups. Betweengroup comparisons as a subtest showed that attention, executive function, and working memory were significantly lower in the COPD group than in the healthy group.

Conclusions

CogEvo can detect specific cognitive impairments associated with COPD, suggesting that it can be potentially used as a screening tool for cognitive impairment in older patients with COPD.

Effect of Problem-solving Treatment on Self-reported Disability Among Veterans With Gulf War Illness: A Randomized Clinical Trial

IMPORTANCE

Few evidence-based treatments are available for Gulf War illness (GWI). Behavioral treatments that target factors known to maintain the disability from GWI, such as problem-solving impairment, may be beneficial. Problem-solving treatment (PST) targets problem-solving impairment and is an evidence-based treatment for other conditions.

OBJECTIVE

To examine the efficacy of PST to reduce disability, problem-solving impairment, and physical symptoms in GWI.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter randomized clinical trial conducted in the US Department of Veterans Affairs compared PST with health education in a volunteer sample of 511 Gulf War veterans with GWI and disability (January 1, 2015, to September 1, 2019); outcomes were assessed at 12 weeks and 6 months. Statistical analysis was conducted between January 1, 2019, and December 31, 2020.

INTERVENTIONS

Problem-solving treatment taught skills to improve problem-solving. Health education provided didactic health information. Both were delivered by telephone weekly for 12 weeks.

MAIN OUTCOMES AND MEASURES

The primary outcome was reduction from baseline to 12 weeks in self-report of disability (World Health Organization Disability Assessment Schedule). Secondary outcomes were reductions in self-report of problem-solving impairment and objective problem-solving. Exploratory outcomes were reductions in pain, pain disability, and fatigue.

RESULTS

A total of 268 veterans (mean [SD] age, 52.9 [7.3] years; 88.4% male; 66.8% White) were randomized to PST (n = 135) or health education (n = 133). Most participants completed all 12 sessions of PST (114 of 135 [84.4%]) and health education (120 of 133 [90.2%]). No difference was found between groups in reductions in disability at the end of treatment. Results suggested that PST reduced problem-solving impairment (moderate effect, 0.42; P = .01) and disability at 6 months (moderate effect, 0.39; P = .06) compared with health education.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial of the efficacy of PST for GWI, no difference was found between groups in reduction in disability at 12 weeks. Problem-solving treatment had high adherence and reduced problem-solving impairment and potentially reduced disability at 6 months compared with health education. These findings should be confirmed in future studies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02161133.

Risk of dementia or cognitive impairment in COPD patients: A meta-analysis of cohort studies

Purpose

A meta-analysis of cohort studies was performed to evaluate the association between COPD and the risk of dementia or cognitive impairment.

Methods

Cohort studies that evaluated the association between COPD and the risk of dementia or cognitive impairment were identified by a systematic search of PubMed, Embase, Web of Science, and Cochrane Library databases. The search time frame was from database establishment to April 12, 2022, with two reviewers independently screening the literature and extracting data. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to conduct the quality evaluation. Then, a meta-analysis was performed using Stata 15.1 software.

Results

Six cohort studies including 428,030 participants were included. The overall quality of the included studies was high, with an average NOS score of over 7. Meta-analysis showed that compared to those without COPD at baseline, patients with COPD were associated with a significant increased risk of dementia (RR = 1.24, 95% CI = 1.03 ~ 1.50, I2 = 96.6%, z = 2.25, p = 0.024) and cognitive impairment (RR = 1.30, 95% CI = 1.13 ~ 1.49, I2 = 50.1%, z = 3.72, p < 0.001). Subgroup analysis suggested no significant difference in the risk of dementia among COPD patients of different genders. Nevertheless, in terms of age, the risk of dementia varied among COPD patients of different ages, which was most distinguished in patients younger than 65 years.

Conclusion

COPD patients have a higher risk of developing dementia or cognitive impairment compared to those without COPD, and this risk is not affected by gender but seems to be associated with age.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022325832.

Cognitive Function and the Ability to Operate Long-Term Oxygen Therapy Equipment: An Exploratory Study

Chronic respiratory disease patients with severe hypoxia receive long-term oxygen therapy (LTOT). The proper operation of LTOT equipment is essential for continuing treatment. This exploratory study investigated the relationship between cognitive impairment as a comorbidity in patients receiving LTOT and their ability to operate the LTOT equipment. The study measured responses to questions based on the ability of participants to operate the equipment and applied the Montreal Cognitive Assessment (MoCA). The ability of groups with MoCA scores ≤ 25 and >25 to operate LTOT equipment was compared to confirm the correlation between MoCA and ability to operate the equipment. An aggregate of 60 participants receiving LTOT were recruited, of whom 45 (75%) were MoCA score ≤ 25. The group of MoCA score ≤ 25 demonstrated a lower ability to operate LTOT equipment than group of MoCA score > 25 (p = 0.012). Additionally, a correlation was found between the ability to operate LTOT equipment and MoCA (rs = 0.743, p < 0.001). The results indicated that the group of MoCA score ≤ 25 indicated a lower ability to operate LTOT equipment than that of MoCA score > 25. Cognitive impairment in patients receiving LTOT can affect their ability to operate LTOT equipment.

Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia risk: A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common public health issue that has been linked to cognitive dysfunction.

AIM

To investigate the relationship between COPD and a risk of mild cognitive impairment (MCI) and dementia.

METHODS

A comprehensive literature search of the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases was conducted. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random or fixed effects model. Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.

RESULTS

Twenty-seven studies met all the inclusion criteria. Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence (OR = 2.11, 95%CI: 1.32-3.38). It also revealed a borderline trend for an increased dementia risk in COPD patients (OR = 1.16, 95%CI: 0.98-1.37). Pooled hazard ratios (HR) using adjusted confounders also showed a higher incidence of MCI (HR = 1.22, 95%CI: -1.18 to -1.27) and dementia (HR = 1.32, 95%CI: -1.22 to -1.43) in COPD patients. A significant lower mini-mental state examination score in COPD patients was noted (MD = -1.68, 95%CI: -2.66 to -0.71).

CONCLUSION

Our findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients. Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.

Understanding barriers to and strategies for medication adherence in COPD: a qualitative study

Background

Medication adherence in chronic obstructive pulmonary disease (COPD) is low, though not enough is known about the factors that affect adherence in COPD. This study uses qualitative methods to understand the patient perspective on facilitators and barriers to medication adherence in COPD as well as patient-reported strategies for self-management of disease.

Methods

Semi-structured interviews were conducted with 30 individuals (n = 30). Transcripts were analyzed using iterative qualitative coding by 2 independent coders, and codes were categorized using thematic analysis.

Results

Challenges with adherence reported were gaps in understanding, forgetfulness of the patient, physician availability, cost navigation, and overcoming substance use. Most commonly, the financial burden of COPD medications caused patients to source other countries to obtain medications, rely on sample medications collected during doctors’ visits, and to alter medication dosage and frequency to extend the length of a prescription. Tools and resources reported by patients to support self-management of COPD included pharmacist assistance, physician office information, and community resources. Individuals further reported that the use of logs or diaries to track medication usage, visual or temporal cues to take medications, and support from family members were helpful in promoting adherence to their COPD medication regimen.

Conclusions

Medication adherence in individuals with COPD is affected by challenges with self-management of disease and financial burden of medications. However, patients reported multiple tools and resources to support adherence. Physician recognition of these factors impacting self-management, as well as awareness of strategies to promote adherence and manage disease, may improve patient outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01892-5.

Impact of Coexisting Dementia on Inpatient Outcomes for Patients Admitted with a COPD Exacerbation

Purpose

People with COPD are at a higher risk of cognitive dysfunction than the general population. However, the additional impact of dementia amongst such patients is not well understood, particularly in those admitted with a COPD exacerbation. We assessed the impact of coexisting dementia on inpatient mortality and length of stay (LOS) in patients admitted to hospital with a COPD exacerbation, using the United States based National Inpatient Sample database.

Patients and Methods

Patients aged over 40 years and hospitalised with a primary diagnosis of COPD exacerbation from 2011 to 2015 were included. Cases were grouped into patients with and without dementia. Multivariable logistic regression analysis, stratified by age, was used to assess risk of inpatient deaths. Cox regression was carried out to compare death rates and competing risk analysis gave estimates of discharge rates with time to death a competing variable.

Results

A total of 576,381 patients were included into the analysis, of which 35,372 (6.1%) had co-existent dementia. There were 6413 (1.1%) deaths recorded. The odds of inpatient death were significantly greater in younger patients with dementia (41–64 years) [OR (95% CI) dementia vs without: 1.75 (1.04–2.92), p=0.03]. Cases with dementia also had a higher inpatient mortality rate in the first 4 days [HR (95% CI) dementia vs without: 1.23 (1.08–1.41), p=0.002] and a longer LOS [sub-hazard ratio (95% CI) dementia vs without: 0.93 (0.92–0.94), p<0.001].

Conclusion

Dementia as a comorbidity is associated with worse outcomes based on inpatient deaths and LOS in patients admitted with COPD exacerbations.

Sedentary Time and Cognitive Impairment in Patients Using Long-Term Oxygen Therapy: A Cross-Sectional Study

Physical inactivity is a predictor of death in patients with chronic respiratory disease. Cognitive impairment is common among patients with chronic respiratory disease. However, the association between sedentary time and cognitive impairment in patients with chronic respiratory disease using long-term oxygen therapy is unclear. This study aimed to determine the relationship between sedentary time and cognitive impairment in patients on long-term oxygen therapy. This cross-sectional study included 96 patients with chronic respiratory disease on long-term oxygen therapy (mean age 77.3 years; female, 22%). The primary outcomes measured were sedentary time (Japanese version of the International Physical Activity Questionnaire Short Form), cognitive function (Montreal Cognitive Assessment), and dyspnea (modified Medical Research Council scale). The factors associated with sedentary time were confirmed by multiple regression analysis. The median sedentary time was 600.0 min. The median Montreal Cognitive Assessment score was 24.0 points, and 67 (70%) patients had mild cognitive impairment. In multiple regression analysis, sedentary time was associated with dyspnea (β = 0.397, p < 0.001) and cognitive function (β = −0.239, p = 0.020). This study indicates that sedentary time in patients on long-term oxygen therapy was associated with dyspnea and cognitive impairment.

A Home-Based Multimedia Pulmonary Rehabilitation Program Improves Clinical Symptoms and Physical Performance of Patients with Chronic Obstructive Pulmonary Disease

Home-based pulmonary rehabilitation can decrease symptoms in chronic obstructive pulmonary disease (COPD) patients. The purpose of this study was to compare the effects of a home-based pulmonary rehabilitation by instructive multimedia in the form of videos and flip charts on clinical symptoms and exercise performance in COPD patients. An eight-week home-based pulmonary rehabilitation program was performed with twenty COPD patients older than 60 years of age with moderate to severe stages. They were separated into two groups: a multimedia group (n = 10) and a control group, which was only provided with telephone monitoring (n = 10). Clinical symptoms were measured by using the clinical COPD questionnaire (CCQ), and exercise performance was measured using a six-minute walk test (6MWT) and an upper-lower limb muscle strengthening test. After 8 weeks, the results showed that both groups showed a statistically significant decrease in the CCQ (p < 0.05). The multimedia group showed a statistically significant increase in the lower-limb muscle strengthening (p < 0.05), while the control group was not found to show a statistically significant increase in the lower-limb muscle strengthening. Therefore, a pulmonary rehabilitation program using multimedia at home can lessen symptoms and improve exercise performance in COPD patients.

Cystic fibrosis-related diabetes (CFRD) and cognitive function in adults with cystic fibrosis

BACKGROUND

Being able to function cognitively is imperative for successful achievement in school, working life, and disease self-management. Diabetes is known to cause changes in brain structure and long-term cognitive dysfunction. This work investigated cystic fibrosis-related diabetes (CFRD) as a mechanism for cognitive impairment in people with CF. It was hypothesised that cognition would be poorer in adults with CFRD than in those with CF without diabetes (CFND) or in healthy controls.

METHODS

Cognitive performance was assessed using the Cambridge Neuropsychological Test Automated Battery which provides a comprehensive cognitive assessment with tests mapping onto specific brain regions. Demographic, clinical and self-reported health data were documented for all participants. CF specific clinical variables were recorded for the two CF groups.

RESULTS

Ninety-eight people with CF (49CFRD,49CFND) and 49 healthy controls were recruited. People with CF demonstrated deficits in aspects of verbal and spatial memory, processing speed and cognitive flexibility compared with healthy controls, with all areas of the brain implicated. Those with CFRD had additional difficulties with higher-level processes known collectively as 'executive function', which demand greater cognitive load and recruit the prefrontal cortex. Compared with healthy controls, those with CFND and CFRD had an estimated 20% and up to 40% reduction in processing speed respectively.

CONCLUSION

Managing CF requires higher order executive function. Impairments may be sufficient to interfere with self-care and the ability to perform everyday tasks efficiently. At which point in the CF disease trajectory these difficulties begin, and what may attenuate them, has yet to be determined.

The provision of dementia care in general practice: practice nurse perceptions of their role

Background

Primary care nurses can assist General Practitioner’s to identify cognition concerns and support patient health self-management for those experiencing cognitive impairment or dementia. This support may lead to more appropriate care and better health outcomes for this group. Consequently, there is a need to identify the role of the primary care nurse in dementia care provision, nurse perceptions of this role and to also understand the barriers and enablers that may influence any current or potential primary care nurse role in dementia care provision.

Methods

Eight focus groups were conducted with a total of 36 primary care nurses. Data was transcribed verbatim and thematically analysed.

Results

There was a high level of agreement between primary care nurses that they had a role in provision of dementia care. This role was largely attributed to the strong therapeutic relationship between nurses and patients. However, dementia care provision was not without its challenges, including a perceived lack of knowledge, limited resources and the hierarchical nature of general practice. Three main themes were identified: personal attributes of the primary care nurse; professional attributes of the primary care nurse role and the context of practice. Six sub-themes were identified: knowing the person; overcoming stigma; providing holistic care; knowing what to do; team culture and working in the system.

Conclusions

The findings of this study suggest primary care nurses have a role in dementia care provision and, there is a need to provide support for the nurse to deliver person-centred health care in the context of cognitive impairment. As the demand for good quality primary care for people living with dementia increases, the role of the primary care nurse should be considered in primary care policy discussions. The knowledge gained from this study could be useful in informing dementia training content, to provide better prompts in the health assessment and care planning templates used by primary care nurses to better identify the care needs of people with a cognitive impairment and to develop dementia care guidelines for primary care nurses.

Benefits of pulmonary rehabilitation in COPD patients with mild cognitive impairment - A pilot study

BACKGROUND

Cognitive impairment might interfere with the efficacy of Pulmonary Rehabilitation (PR) in Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify differential responses to PR between cognitively impaired (CI) and cognitively normal (CN) COPD patients by assessing health status and exercise capacity.

METHODS

Sixty patients (FEV₁: 47 ± 15%) were classified as CI or CN according to the Montreal Cognitive Assessment (MoCA ≤25points) and completed a 3-week inpatient PR program. Cognitive function (neuropsychological battery), health-status (36-Item Short Form Survey [SF-36]), and exercise capacity (6-min walk test [6MWT], cycle-endurance test [CET]) were assessed before and after PR. Responsiveness to PR was estimated by mean change (delta-value [Δ]) and the d-Effect Size (ES).

RESULTS

Twenty-five COPD patients (42%) presented evidence of mild CI prior to PR. Both, CI and CN patients significantly improved global cognitive function, health status (the majority of SF-36 components), and exercise capacity (6MWT and cycle endurance) in response to PR. Compared to CN, CI patients did not improve SF-36 subdomains of "role emotional" and "bodily pain", and demonstrated a lower magnitude of improvement in 6MWT ([Δ]: 25 m; ES: 0.21) compared to CN ([Δ]: 46 m; ES: 0.54).

CONCLUSIONS

PR has favorable effects on global cognitive function, health status, and exercise capacity in both CI and CN COPD patients. There was no concrete evidence to indicate interference of cognitive impairment to PR effectiveness.

Effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease

AIM

The study purpose was to investigate effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease.

BACKGROUND

Cognitive impairment is frequently observed in chronic obstructive pulmonary disease patients, and it interferes with many aspects of self-management, which is fundamental to disease management and quality of life.

DESIGN

The design is quasi-experimental.

METHODS

Data collection was performed between June 2018 and March 2019. Study participants were 60 in- or out-patients with chronic obstructive pulmonary disease. The cognitive rehabilitation programme involved six 30-min sessions administered over a period of 2 weeks and consisted of six areas: attention, memory, language, visuospatial perception, executive function and problem solving. Cognitive function, self-management and quality of life were measured at three times (preintervention and immediately and 4 weeks after intervention).

RESULTS

Cognitive function, self-management and quality of life were found to be significantly improved over time after administration of the cognitive rehabilitation programme. However, no significant improvement was observed in the control group.

CONCLUSIONS

Our findings support the potential usefulness of cognitive intervention to promote cognitive function, self-management ability and quality of life in patients with chronic obstructive pulmonary disease.

Self-perceived cognitive status and cognitive challenges associated with cardiac rehabilitation management: experiences of elderly myocardial infarction patients

PURPOSE

The study aimed to explore the self-perceived cognitive status and cognitive challenges associated with lifestyle changes in cardiac rehabilitation among elderly myocardial infarction (MI) patients (≥65 years). Further, the study explored coping strategies developed to manage these challenges in the everyday life.

METHODS

Nine patients were included in the study. Data were collected by telephone or in person, between 6 and 12 weeks post MI, using semi-structured interviews. Data were analysed inductively, using thematic analysis.

RESULTS

Four major themes were identified, highlighting elderly MI patients' experiences of their cognitive status and cardiac rehabilitation management: (1) A change in cognition over time, (2) Situating the MI within a challenging and changing life context, (3) Navigating the hurdles of cardiac rehabilitation, and (4) Being seen within the healthcare system.

CONCLUSION

Elderly MI patients are situated in a complex life context, dealing with a transition to retirement, multiple health issues and age-related cognitive decline. In this context, the MI experience is marginalised, and cognitive decline normalized. By adopting individually tailored interventions and improving healthcare provider continuity and accessibility, cognitive challenges associated with cardiac rehabilitation could be easier to overcome.IMPLICATIONS FOR REHABILITATIONSelf-perceived cognitive impairment, in particular regarding memory, seems fairly common among elderly MI patients and should likely be identified prior to hospital discharge in order to optimize the prospects of self-care.There seems to exist an unmet need to implement the practice of individually adapted education and information further, in accordance with current recommendations for elderly cardiac patients.The overall health and cognitive status, social network and the objective living conditions (e.g., distance from service and housing) should be taken into account when planning the patient's cardiac rehabilitation management.Healthcare providers likely need to strengthen the continuity of care and increase its accessibility for elderly MI patients, in particular following the transfer from hospital care to local health centres.

Effect of nutritional risk on cognitive function in patients with chronic obstructive pulmonary disease

Objective

We aimed to clarify the cognitive function of patients with chronic obstructive pulmonary disease (COPD) and different nutritional status.

Methods

Among 95 patients with COPD in this retrospective study, we administered the Nutritional Risk Screening 2002 (NRS 2002) and Mini-Mental State Examination (MMSE). We recorded patients’ clinical characteristics, comorbidities, and laboratory measurements. According to NRS 2002 scores, patients were divided into two groups: no nutritional risk with NRS 2002 < 3 (n = 54) and nutritional risk, with NRS 2002 ≥ 3 (n = 41).

Results

We found a negative correlation between NRS 2002 and MMSE scores in participants with COPD (r = −0.313). Patients with nutritional risk were more likely to be cognitively impaired than those with no nutritional risk. Multivariate logistic regression analysis indicated that malnutrition was an independent risk factor for cognitive impairment, after adjusting for confounders (odds ratio [OR] = 4.120, 95% confidence interval [CI]: 1.072–15.837). We found a similar association between NRS 2002 and MMSE scores at 90-day follow-up using a Pearson’s correlation test (r = −0.493) and logistic regression analysis (OR = 7.333, 95% CI: 1.114–48.264).

Conclusions

Patients with COPD at nutritional risk are more likely to have cognitive impairment.

Abnormal intrinsic functional hubs and connectivity in stable patients with COPD: a resting-state MRI study

Chronic obstructive pulmonary disease (COPD) affects a large population and is closely associated with cognitive impairment. However, the mechanisms of cognitive impairment in COPD patients have not been unraveled. This study investigated the change in patterns of intrinsic functional hubs using a degree centrality (DC) analysis. The connectivity between these abnormal hubs with the remaining brain was also investigated using functional connectivity (FC). Nineteen stable patients with COPD and 20 normal controls(NC) underwent functional magnetic resonance imaging (MRI) examinations and clinical and neuropsychologic assessments. We measured the voxel-wise DC across the whole brain gray matter and the seed-based FC between these abnormal hubs in the remaining brain matter; the group difference was calculated. A partial correlation analysis was performed to assess the relationship between the abnormal DC and clinical variables in COPD patients. Compared to NC, the patients with COPD exhibited significantly decreased DC in the right lingual gyrus (LG), bilateral supplementary motor area (SMA), and right paracentral lobule (PCL). A further seed-based FC analysis found that COPD patients demonstrated significantly decreased FC between these abnormal hubs in several brain areas, including the left cerebellum anterior lobe, left lingual gyrus, left fusiform gyrus, right insula, right inferior frontal gyrus, limbic lobe, cingulate gyrus, left putamen, lentiform nucleus, right precuneus, and right paracentral lobule. A partial correlation analysis showed that the decreased DC in the right PCL was positively correlated with the FEV1 and FEV1/FVC, and the decreased DC in the SMA was positively correlated with naming and pH in COPD patients. This study demonstrates that there are intrinsic functional hubs and connectivity alterations that may reflect the aberrant information communication in the brain of COPD patients. These findings may help provide new insight for understanding the mechanisms of COPD-related cognitive impairment from whole brain functional connections.

Extra-pulmonary manifestations of COPD and the role of pulmonary rehabilitation: a symptom-centered approach

Introduction: Chronic obstructive pulmonary disease (COPD) is a complex and heterogenous disease that is associated with a range of respiratory and non-respiratory symptoms, which highly contribute to the daily burden of the disease. Symptoms burden remains high despite optimal bronchodilator therapy, but pulmonary rehabilitation (PR) is an effective intervention to improve patients' symptoms. A comprehensive interdisciplinary approach within the framework of a PR program is warranted to tackle these complex symptoms and their consequences. Areas covered: This narrative review describes how symptoms of dyspnea, fatigue, cough, sputum, anxiety, depression, pain, sleep disturbances, and cognitive decline arise in COPD and can contribute to several non-pulmonary manifestations of the disease. It also describes evidence of the effectiveness of interdisciplinary PR programs to counteract these symptoms. A literature search was performed on PubMed and Scopus between June and July 2020. Expert opinion: Respiratory and non-respiratory symptoms are highly prevalent, often not comprehensively assessed, and result in several extra-pulmonary manifestations of the disease (physical, emotional and social). Interdisciplinary PR programs can improve these negative manifestations through different pathways, contributing for an effective symptoms' management. A thorough assessment of symptoms (beyond dyspnea) should be routinely performed and may support the identification of treatable traits, allowing the tailoring of PR interventions and assessment of their real-life impact.

Cognitive function following pulmonary rehabilitation and post-discharge recovery from exacerbation in people with COPD

BACKGROUND

Cognitive impairment (CI) is prevalent in COPD and is associated with poor health-related quality of life. Recovery of cognition following an acute exacerbation of COPD (AECOPD), the impact of CI on pulmonary rehabilitation (PR) uptake and the effect of PR on CI are not fully understood.

METHODS

This 6-week prospective study analysed 67 people with stable COPD symptoms who completed PR (PR group) and the recovery of 45 people admitted for AECOPD (AECOPD group). All participants were assessed for cognitive function (Montreal Cognitive Assessment [MoCA]), health status (COPD Assessment Test, Chronic Respiratory Questionnaire), lower extremity function (Short Physical Performance Battery), and psychological well-being (Hospital Anxiety and Depression Score). Follow up assessments were carried out after a 6-week recovery post-discharge in AECOPD group and after PR in the PR group.

RESULTS

AECOPD group showed no improvement in MoCA following a 6-week recovery post-discharge (Δ-0.8 ± 3.2, p = 0.205), despite improvements in all other clinical outcomes. PR uptake among the AECOPD group was not associated with the presence of CI (p = 0.325). Participants in the PR group with CI at baseline showed a significant improvement in MoCA score following PR (Δ1.6 ± 2.4, p = 0.004).

CONCLUSIONS

Cognition does not improve following 6-week recovery post-AECOPD, and CI may influence patients' response to PR referral as an inpatient. PR improves cognition in people with stable COPD symptoms and CI. People with AECOPD should be actively encouraged to attend PR irrespective of mild-moderate cognition but may require additional support or opportunities to take part.

Ideational Fluency in Patients with Rheumatoid Arthritis

BACKGROUND

Neuropsychiatric symptoms have been well documented in several systemic inflammatory conditions, for example, systemic lupus erythematosus (SLE). Increased prevalence of cognitive decline and psychiatric issues has been reported in patients with rheumatoid arthritis (RA). However, there is limited evidence of which exact cognitive domains are affected and to what degree.

AIM

To test the performance of cognition in the domain of ideational fluency (Thing Categories Test in particular) in patients with RA and compare the results with the general population and to the results with cognitive and depression screening scores in both groups.

METHODS

Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) assessment, Montreal Cognitive Assessment (MoCA), and Thing Categories Test (TCT) were used to evaluate patients with RA, as well as the control group.

RESULTS

Twenty patients with RA and 20 controls were tested, with 7 and 4 men, and 13 and 16 women in the study and control group, respectively. Average scores in TCT at three minutes were 7.50 (IQR6.0-10.0) and 6.0 (IQR3.0-8.0) for category "blue"; 17.50 (IQR15.0-19.0) and 16.0 (10.0-18.0) for category "round" in the control and study group, respectively. A statistically significant difference was established between the study and the control group in TCT for the category "blue" (p<0.025). The average score for GAD7 was 2.0 (IQR 0.0-5.75) and 3.0 (IQR0.50-6.00) in the control and study group, respectively. The average score for PHQ-9 was 2.0 (IQR0.25-4.75) and 4.0 (IQR2.00-5.50) in the control and study group, respectively. Finally, the average score for the MoCA scale was 27.0 (IQR25.25-28.00) and 26.0 (IQR23.50-28.00) in the control and study group, respectively.

CONCLUSION

Preliminary evidence suggests that RA at least partially affects the cognitive domain of ideational fluency. However, further research with larger experimental groups is needed to provide more conclusive evidence.

Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study

OBJECTIVES

This study aimed to investigate the relationship between disability and domain-specific cognitive function in older adults with chronic obstructive pulmonary disease (COPD).

DESIGN

Cross-sectional analyses combined with retrospective longitudinal analyses.

SETTING

We included 450 communities in China.

PARTICIPANTS

In this study, 1022 (mean age: 68.6±6.3; 612 males) and 152 (mean age: 67.0±5.2; 83 males) older adults with COPD from the China Health and Retirement Longitudinal Study were included in a cross-sectional multivariate linear regression analysis and a longitudinal logistic regression analysis, respectively.

OUTCOME MEASURES

Disability was determined by the difficulty or inability to complete 1 of the 12 activity items in basic activities of daily living (ADL) and instrumental ADL. The cognitive dimensions of episodic memory, attention/numerical ability, orientation to time, and visuospatial ability were assessed via the immediate/delayed recall task, serial sevens task, naming the current date and pentagon-figure-drawing tasks, respectively.

RESULTS

Of 1022 older respondents with COPD at wave-4, 48.5% had ADL disability. Declines in the global cognitive function (β (95% CI)=-0.627 (-1.214 to -0.040)), orientation to time (β (95% CI)=-0.207 (-0.364 to -0.050)) and visuospatial ability (β (95% CI)=-0.068 (-0.127 to -0.009)) were significantly associated with the presence of ADL disability, when demographic and health-related variables were adjusted. Of 152 older participants with COPD and without ADL disability in wave-2, 61 (40.1 %) developed disability over a 2-year follow-up. Relative to the participants without a decline in orientation to tine, those with the condition had greater odds of incidence of ADL disability increased by a factor of about 1.46 over a 2-year follow-up.

CONCLUSIONS

In older adults with COPD, orientation to time and visuospatial inability are vulnerable to the presence of a disability. Prevention of a decline in orientation to time might help prevent disability in older people with COPD.

Cognitive performance in relation to metabolic disturbances in patients with COPD

BACKGROUND & AIMS

Cognitive impairment (CI) and metabolic abnormalities, including the metabolic syndrome (MetS) and sarcopenia, are more prevalent in COPD patients compared to controls without diagnosed lung disease. Because earlier studies have shown these metabolic abnormalities may affect cognitive performance, this study investigated whether cognitive performance is more impaired in subgroups of COPD patients with MetS or sarcopenia.

METHODS

Cognitive performance patterns of 170 COPD patients referred for pulmonary rehabilitation (53.5% male, 63.4 ± 9.4 years, FEV₁ 54.5 ± 22.7% predicted) were compared between COPD subgroups stratified by presence of MetS and sarcopenia. Cognitive performance was assessed using a detailed neuropsychological test battery, which measured psychomotor speed (Stroop Color-Word Test, Concept Shifting Test, Letter-Digit Substitution Test), planning (Behavioral Assessment of the Dysexecutive Syndrome), working memory (Visual-Verbal Learning Test, Digit Span), verbal memory (Visual-Verbal Learning Test) and cognitive flexibility (Stroop Color-Word Test, Concept Shifting Test). MetS was determined according to the NCEP ATP-III criteria. Sarcopenia was determined based on decreased appendicular lean mass by dual-energy x-ray absorptiometry and impaired physical performance by 6-min walking distance.

RESULTS

MetS was observed in 54.7% and sarcopenia in 30.0% of COPD patients. The prevalence of general CI was not different between patients with and without MetS (30.4% and 39.0%, respectively) or those with and without sarcopenia (34.0% and 34.5%, respectively, both p > 0.05). Domain-specific cognitive performance was not different between metabolic subgroups, but those with sarcopenia displayed a lower prevalence of CI on verbal memory than those without (21.7% and 29.7%, respectively, p = 0.011). Only the digit span (working memory) subtest was significantly different between metabolic subgroups, in favor of those without MetS (p = 0.017).

CONCLUSION

Cognitive performance was not affected more in COPD patients with sarcopenia or MetS.

[Integrated care management for older people with chronic diseases in domesticity: evidence from Cochrane reviews]

Hintergrund

Die Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor.

Ziel der Arbeit

Bewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland.

Methoden

Systematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein.

Ergebnisse

Aus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme.

Schlussfolgerungen

Die identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01796-1) enthalten.

Intrinsic low-frequency oscillation changes in multiple-frequency bands in stable patients with chronic obstructive pulmonary disease

Abnormal local spontaneous brain activity during the resting state has been observed in chronic obstructive pulmonary disease (COPD). However, it is still largely unclear whether the abnormalities are related to specific frequency bands. Our purpose was to explore intrinsic neural activity changes in different frequency bands by using the amplitude of low-frequency fluctuation (ALFF) method in stable COPD patients. Nineteen stable COPD patients and twenty gender-, age- and education-matched normal controls (NCs) underwent functional magnetic resonance imaging scans, cognitive function tests and lung function tests. Two different frequency bands (slow-4: 0.027-0.073 Hz; slow-5: 0.01-0.027 Hz) were calculated and analyzed for frequency-dependent intrinsic neural activity by using the ALFF method. A two-way analysis of variance test was used to compare the main effects of the groups and the frequency bands in the ALFF method. Further post-hoc t-tests were used to compare the differences between COPD patients and NCs in terms of the different frequency bands. A Pearson's correlation analysis was performed to explore the relationship between the altered ALFF brain areas in the different frequency bands and the clinical evaluations in the COPD patients. There were main effects of the groups including significantly higher ALFF values in the right superior temporal gyrus (STG), the bilateral cerebellum posterior lobe (CPL), the right lingual gyrus (LG) and the right brainstem, and as well as significantly decreased ALFF values in the right inferior parietal lobule (IPL) and the angular. The main effect of frequency was demonstrated in the CPL, the STG, the prefrontal cortex and the middle cingulate gyrus. Furthermore, COPD patients exhibited more widespread alterations in intrinsic brain activity in the slow-5 band than in the slow-4 band. Moreover, the abnormal intrinsic brain activity in the slow-4 and slow-5 bands were associated with PaCO₂ in COPD patients. These current results indicated that COPD patients showed abnormal intrinsic brain activity in two different frequency bands, and abnormal intrinsic neuronal activity in different brain regions could be better detected by slow-5 band. These observations may provide a neoteric view into understanding the local neural psychopathology in stable COPD patients.

Carotid Artery Stiffness is Associated With Cognitive Performance in Former Smokers With and Without Chronic Obstructive Pulmonary Disease

Background

Heavy smokers perform worse on neuropsychological assessment than age‐matched peers. However, traditional pulmonary measures of airflow limitation and hypoxemia explain only a modest amount of variance in cognition. The current objective was to determine whether carotid artery stiffness is associated with cognition in former smokers beyond the effects of amount of smoking and pulmonary function.

Methods and Results

Eighty‐four former smokers including individuals across a spectrum of airflow limitation severity were included: 30 without chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease [GOLD] 0 with normal spirometry and lung computed tomography), 31 with mild‐moderate chronic obstructive pulmonary disease (GOLD 1–2), and 23 with severe‐very severe chronic obstructive pulmonary disease (GOLD 3–4). Participants completed questionnaires, spirometry, carotid ultrasonography, and neuropsychological testing. Multiple linear regression was used to determine whether carotid artery stiffness is associated with neuropsychological performance in 4 cognitive domains after adjusting for age, sex, pack‐years of smoking, estimated premorbid intellectual functioning, and airflow limitation. Higher carotid artery β‐stiffness index was associated with reduced executive functioning‐processing speed in the fully adjusted model (β=−0.49, SE=0.14; P=0.001). Lower premorbid intellectual function, male sex, and presence of airflow limitation (GOLD 1 or 2 and GOLD 3 or 4) were also associated with worse executive functioning‐processing speed. β‐Stiffness index was not significantly associated with performance in other cognitive domains.

Conclusions

Carotid artery stiffness is associated with worse performance on executive functioning‐processing speed in former smokers beyond the effects of aging, amount of past smoking, severity of airflow limitation, and hypoxemia. Future research should examine whether carotid stiffness can be used to identify former smokers at risk for subsequent cognitive impairment.

From Mild Cognitive Impairment (MCI) to Dementia in Chronic Obstructive Pulmonary Disease. Implications for Clinical Practice and Disease Management: A Mini-Review

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease characterized by partially irreversible chronic airflow limitation. Current literature highlights that COPD patients also have an increased risk to develop Mild Cognitive Impairment (MCI) and dementia. Chronic patients with cognitive impairment experience a worsening of health-related quality of life, mainly because it could affect treatment self-management, medication adherence and personal independence. Moreover, they also report high levels of anxiety and depression, which are associated with disease severity, poor quality of life, poor adherence to rehabilitation programs and difficulties in self-management. In current literature, there is a lack of studies describing simultaneously the associations between cognitive impairment, dysfunctional psychosocial factors, self-management abilities and their impact on pharmacological/non-pharmacological adherence. Therefore, the aim of the present short review is to describe the implications of cognitive impairment and psychosocial factors for clinical practice and disease management in COPD patients. Due to the interaction of these factors on adherence to rehabilitation programs, self-management and rehabilitation completion, future research should investigate simultaneously the role of all these different aspects to individuate a specific clinical approach that might include specific screening tools to evaluate cognitive impairment and psychosocial difficulties. A timely specific evaluation, within an interdisciplinary approach, could help to implement a more individualized and personalized treatment.

Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD

This study explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial.

A 12-week, four-group, randomised, partially double-blind, placebo-controlled, parallel-group trial of SMBM in addition to tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, tiotropium/olodaterol 5/5 µg plus ExT, or placebo was conducted in 304 patients. Outcomes included anxiety (Hospital Anxiety and Depression Scale (HADS)-A), depression (HADS-D and Patient-Health Questionnaire (PHQ)-9) and cognitive function (Montreal Cognitive Assessment (MoCA)).

All outcomes showed statistically and clinically significant improvements after 12 weeks independent of treatment group. However, greater improvements in HADS-A and MoCA were seen in patients who exhibited greater increases in physical activity and exercise capacity, respectively, whereas greater improvements in HADS-D and PHQ-9 were seen in patients who exhibited increases in either physical activity or exercise capacity.

The results indicate that SMBM with/without bronchodilators or ExT was associated with improved psychological and cognitive functioning. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD.

Behavioural modification adjunct to bronchodilator therapy and exercise training to increase exercise capacity and physical activity can also be beneficial for improving anxiety, cognitive function and depression in patients with COPDhttp://bit.ly/33ZufNM

Supporting self-care of long-term conditions in people with dementia: A systematic review

BACKGROUND

Long-term conditions are common in people living with dementia; their self-management is an important determinant of wellbeing. Family carers often support or substitute self-care activities, and act as proxies for self-management, as dementia progresses.

OBJECTIVES

To conduct the first systematic review of how management of long-term conditions in people with dementia is best enabled and supported, including factors that facilitate or inhibit self-management and management by a proxy.

DESIGN

Systematic review.

DATA SOURCES

We systematically searched MEDLINE, PsychINFO, Embase and Allied and Complementary Medicine databases up to November 2018.

REVIEW METHODS

We identified the long-term conditions most prevalent in people with dementia that require an element of self-management. We then developed our inclusion criteria to identify qualitative and quantitative studies describing the self-management (or self-management assisted by family carers) of long-term conditions in people with dementia. Two authors independently rated study validity using a standardised checklist. We synthesised qualitative and quantitative findings using a data driven convergent synthesis approach.

RESULTS

We included 12 articles meeting predetermined inclusion criteria: seven qualitative, two case studies, two quantitative and one mixed methods study. We identified four main themes across these studies: (1) dementia symptoms impeding treatment regimens (forgetfulness, decreased understanding, ability to communicate symptoms and behavioural and psychological symptoms); (2) adapting routines to be simpler, (using memory aids and accommodating physical limitations); (3) negotiating self-management support (carer availability and knowledge; balancing needs for safety and empowerment); and (4) interface with professionals, (Routine simplification, condition specific education, and acknowledging carer role).

CONCLUSIONS

People living with dementia can be supported to manage their own health for as long as possible, through simplifying routines and reminding, but where this can no longer be negotiated, carers take over responsibility for self-management, often due to safety concerns. Empowerment of people with dementia to remain involved in their care reduces the loss experienced by this transition. Communication and partnership between clinicians and carers is critical when supporting people living with a long-term condition and dementia. Care planning for people living with dementia and a long-term condition should include explicit discussion of how these partnerships will work and guidance on strategies carers can use to support people to self-manage long-term conditions.

Chronic disease management and dementia: a qualitative study of knowledge and needs of staff

Effective self-management is the cornerstone of chronic disease self-management. However, self-management of chronic disease in patients with comorbid dementia is particularly challenging. It is vital that clinicians, patients and carers work collaboratively to tailor self-management programs to each patient with dementia. This study aimed to identify barriers and facilitators of successful self-management in the context of cognitive impairment in order to optimise the capacity for self-management for persons with dementia (PWD). A qualitative study based on semistructured interviews was conducted in Victoria, Australia. Interviews were conducted with 12 people (employed in the ambulatory and dementia care sectors), representing six health services. Participants identified a healthcare system that is complex, not dementia friendly and not accommodating the needs of PWD who have comorbidities. Individual and systemic barriers contributed to ineffective self-management. Chronic disease support programs do not routinely undertake cognitive assessment or have guidelines for modified management approaches for those with cognitive impairment. Support needs to be long-term and requires a specialised skillset that recognises not only chronic disease management, but also the effect of cognition on self-management. Although formal guidelines are needed, care also needs to be tailored to individual cognitive abilities and deficits.

Association between Chronic Obstructive Pulmonary Disease and Dementia: Systematic Review and Meta-Analysis of Cohort Studies

Background

Chronic obstructive pulmonary disease (COPD) is a common disease among the elderly, which has been linked to cognitive decline. However, the relationship between COPD and dementia remains unclear.

Summary

We conducted a systematic literature review by searching databases such as Pubmed, Embase, EBSCO, and Cochrane Library (from inception to April 18, 2018) for studies on COPD that also investigated the prevalence of dementia. We found 3 cohort studies including a total of 39,392 COPD patients. Then we applied the Newcastle-Ottawa Scale to evaluate the risk of bias.

Key Messages

COPD patients faced a higher risk of dementia (HR 1.46; 95% CI 1.22–1.75; p < 0.001). Subgroup analysis on gender determined that the association between COPD and dementia was stronger in male patients (HR 1.49, 95% CI 1.20–1.86, p < 0.001) than in female patients (HR 1.41, 95% CI 1.27–1.57, p < 0.001). A subset study of patients aged >65 years revealed that the HR was greater for patients aged ≥75 years (HR 1.46, 95% CI 1.07–2.00, p = 0.02) than for those aged 65–74 years (HR 1.40, 95% CI 1.28–1.53, p < 0.001). The cohort studies included were from similar population-based databases, suggesting possible regional limitations and publication bias.

Medication management patterns among Medicare beneficiaries with chronic obstructive pulmonary disease who initiate nebulized arformoterol treatment

Purpose: Global evidence-based treatment strategies for chronic obstructive pulmonary disease (COPD) recommend using long-acting bronchodilators (LABDs) as maintenance therapy. However, COPD patients are often undertreated. We examined COPD treatment patterns among Medicare beneficiaries who initiated arformoterol tartrate, a nebulized long-acting beta2 agonist (LABA), and identified the predictors of initiation. Methods: Using a 100% sample of Medicare administrative data, we identified beneficiaries with a COPD diagnosis (ICD-9 490-492.xx, 494.xx, 496.xx) between 2010 and 2014 who had ≥1 year of continuous enrollment in Parts A, B, and D, and ≥2 COPD-related outpatient visits within 30 days or ≥1 hospitalization(s). After applying inclusion/exclusion criteria, three cohorts were identified: (1) study group beneficiaries who received nebulized arformoterol (n=11,886), (2) a subset of the study group with no LABD use 90 days prior to initiating arformoterol (n=5,542), and (3) control group beneficiaries with no nebulized LABA use (n=220,429). Logistic regression was used to evaluate predictors of arformoterol initiation. Odds ratios (ORs), 95% confidence intervals (CIs), and p values were computed. Results: Among arformoterol users, 47% (n=5,542) had received no LABDs 90 days prior to initiating arformoterol. These beneficiaries were being treated with a nebulized (50%) or inhaled (37%) short-acting bronchodilator or a systemic corticosteroid (46%), and many received antibiotics (37%). Compared to controls, beneficiaries who initiated arformoterol were significantly more likely to have had an exacerbation, a COPD-related hospitalization, and a pulmonologist or respiratory therapist visit prior to initiation (all p<0.05). Beneficiaries with moderate/severe psychiatric comorbidity or dual-eligible status were significantly less likely to initiate arformoterol, as compared to controls (all p<0.05). Conclusion: Medicare beneficiaries who initiated nebulized arformoterol therapy had more exacerbations and hospitalizations than controls 90 days prior to initiation. Findings revealed inadequate use of maintenance medications, suggesting a lack of compliance with evidence-based treatment guidelines.

Disrupted resting-state spontaneous neural activity in stable COPD

Introduction and aim

Abnormal brain structure and function in COPD has been reported on MRI. However, the deficit in local synchronization of spontaneous activity in patients with stable COPD remains unknown. The main aim of the present study was to explore spontaneous brain activity in patients with COPD compared with normal controls using the regional homogeneity (ReHo) method based on resting-state functional MRI.

Methods

Nineteen patients with stable COPD and 20 well-matched (including age, sex, and number of years of education) normal controls who were recruited for the present study underwent resting-state functional MRI examinations and a series of neuropsychological and clinical assessments. The ReHo method was used to assess the strength of local brain signal synchrony. The mean ReHo values in brain areas with abnormal ReHo were evaluated with a receiver operating characteristic curve. The relationships between the brain regions with altered ReHo values and the clinical and neuropsychological parameters in COPD patients were assessed using Pearson’s correlation.

Results

Patients with COPD showed significantly lower ReHo values in the left occipital lobe and the right lingual, bilateral precuneus, and right precentral gyrus. The result of receiver operating characteristic curve analysis showed that the altered average ReHo values have high efficacy for distinguishing function. The mean lower ReHo values in the precuneus gyrus showed a significant positive correlation with FEV₁%, FEV₁/FVC, and orientation function but a significant negative correlation with arterial partial pressure of carbon dioxide.

Conclusion

The COPD patients demonstrated abnormal synchrony of regional spontaneous activity, and the regions with abnormal activity were all correlated with visual processing pathways, which might provide us with a new perspective to further understand the underlying pathophysiology of cognitive impairment in patients with COPD.

New insights to improve treatment adherence in asthma and COPD

Chronic respiratory diseases such as asthma and COPD are typically managed by daily inhaled medication. However, the efficacy of an inhaled medication depends upon a patient's adherence to therapy, which refers to whether the medication is actually taken as prescribed. In patients with these diseases, higher adherence has been associated with better health outcomes, such as improved disease control and a reduction in severe and potentially costly exacerbations. Adherence is a multifaceted concept that includes medication-related, intentional, and unintentional reasons that patients may or may not take their medication as directed. The purpose of this integrative review is to present the individual patient factors that contribute to suboptimal adherence to inhaled therapies and the associated effects on health outcomes, while also highlighting evidence-based strategies for health care providers to improve adherence to such therapies in patients with asthma or COPD. Working closely with patients to establish a model of shared decision-making, which takes patient beliefs and preferences into account when choosing treatment options, has the potential to improve adherence and overall patient outcomes in the management of asthma and COPD.

COPD patients hospitalized with exacerbations have greater cognitive impairment than patients hospitalized with decompensated heart failure

PURPOSE

People with COPD have cognitive dysfunction, which is greater in those hospitalized for exacerbations than in stable outpatients. We tested the hypothesis that cognitive dysfunction at exacerbation is a disease-specific feature of COPD, rather than a nonspecific feature of hospitalization for acute illness, by comparing cognition between patients hospitalized for acute COPD exacerbations and those with worsening heart failure (HF).

PATIENTS AND METHODS

A total of 40 hospital inpatients were recruited, 20 patients with COPD exacerbations and 20 patients with congestive or left-sided HF. Exclusion criteria included previous stroke, known neurological disease, and marked alcohol excess. Participants completed the Montreal cognitive assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) and underwent spirometry and review of clinical records.

RESULTS

Age (mean±SD, COPD 73±10; HF 76±11 years), acute illness severity (Acute Physiology and Chronic Health Evaluation [APACHE]-II, COPD 15.4±3.5; HF 15.9±3.0), comorbidities (Charlson index, COPD 1.3±1.9; HF 1.6±1.5), and educational background were similar between COPD and HF groups. MoCA total was significantly lower in COPD than in HF (COPD 20.6±5.6; HF 24.8±3.5, P=0.007); however, significance was lost after correction for age, sex, and pack year smoking history. When compared with HF patients, the COPD cohort performed worse on the following domains of the MoCA: visuospatial function (median [IQR], COPD 0 [1]; HF 2 [1], P=0.003), executive function (COPD 2 [1]; HF 3 [1], P=0.035), and attention (COPD 4 [3]; HF 6 [2], P=0.020). Age (P=0.012) and random glucose concentration (P=0.041) were associated with cognitive function in whole group analysis, with pack year smoking history reaching borderline significance (P=0.050).

CONCLUSION

Total MoCA score for COPD and HF indicated that both groups had mild cognitive impairment, although this was greater in people with COPD. Mechanisms underlying the observed cognitive dysfunction in COPD remain unclear but appear related to blood glucose concentrations and greater lifetime smoking load.

Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both?

COPD is a chronic lung disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities. Furthermore, COPD is often characterized by extrapulmonary manifestations and comorbidities worsening COPD progression and quality of life. A neglected comorbidity in COPD management is mental health impairment defined by anxiety, depression and cognitive problems. This paper summarizes the evidence for impaired mental health in COPD and focuses on current pharmacological intervention strategies. In addition, possible mechanisms in impaired mental health in COPD are discussed with a central role for inflammation. Many comorbidities are associated with multi-organ-associated systemic inflammation in COPD. Considering the accumulative evidence for a major role of systemic inflammation in the development of neurological disorders, it can be hypothesized that COPD-associated systemic inflammation also affects the function of the brain and is an interesting therapeutic target for nutra- and pharmaceuticals.