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Chen X, Song H, Liu J, He Y, Wei L, Deng M, Zhang R, Huang Y, Yang Y. The impact of cognitive impairment on patient activation and their value in self-management among COPD patients. PATIENT EDUCATION AND COUNSELING 2024; 129:108397. [PMID: 39190988 DOI: 10.1016/j.pec.2024.108397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 07/03/2024] [Accepted: 08/08/2024] [Indexed: 08/29/2024]
Abstract
OBJECTIVES To examine the impact of the interaction between cognitive function and patient activation on self-management behaviors among COPD patients. METHODS We conducted a study of 331 COPD patients. Cognitive function and patient activation were evaluated at baseline, relevant information on social demography and diseases was collected simultaneously. The primary outcome was self-management behaviors. We performed a multiple logistic regression analysis to evaluate the interaction between cognitive function and patient activation. RESULTS We found the interaction between mild cognitive impairment (MCI) and low patient activation on poor self-management behaviors was multiplicative. The proportion of participants with high patient activation was lower than those with low patient activation among patients with MCI. The incidence of poor self-management behaviors in patients with normal cognition differed significantly between participants with different activation levels (90.2 % vs.31.3 % vs.9.7 %). However, the difference was small in those with MCI (94 % vs. 73.5 % vs. 84.5). Notably, poor self-management behaviors were high among patients with MCI, regardless of their activation level. CONCLUSIONS Patients with COPD are more likely to have poor self-management behaviors when MCI and low patient activation coexist, and it was difficult to be activated for patients with MCI. PRACTICE IMPLICATIONS The assessment of cognitive function is crucial for patients with COPD, especially those with low activation.
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Affiliation(s)
- Xiaomei Chen
- Department of Nursing, Chengdu Wenjiang District People's Hospital, Chengdu, PR China; School of Nursing, Army Medical University, PR China
| | - Huiqin Song
- Nursing department, Medical Center Hospital of Qionglai City, Chengdu, PR China
| | - Jia Liu
- School of Nursing, Army Medical University, PR China
| | - Yuxuan He
- School of Nursing, Army Medical University, PR China
| | - Li Wei
- School of Nursing, Army Medical University, PR China
| | - Menghui Deng
- School of Nursing, Army Medical University, PR China
| | - Rui Zhang
- Department of Chest Surgery, Medical Center Hospital of Qionglai, PR China
| | - Yan Huang
- Department of neurology, Medical Center Hospital of Qionglai, PR China
| | - Yanni Yang
- School of Nursing, Army Medical University, PR China.
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Chen X, Li J, Liu J, Liu X, Deng M, Dong X, Yang Y. The association of sun-cured tobacco and cigarette use with global cognitive function, verbal fluency and memory in patients with chronic obstructive pulmonary disease: A cross-sectional study. Tob Induc Dis 2024; 22:TID-22-09. [PMID: 38229665 PMCID: PMC10789182 DOI: 10.18332/tid/175973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Some elderly people in China prefer sun-cured tobacco to cigarettes, and the composition of sun-cured tobacco and cigarettes is inconsistent. The influence of cigarettes on the cognitive function of COPD patients has been widely reported, but the research on sun-cured tobacco is relatively rare. Our study explored the association of sun-cured tobacco and cigarette use with cognitive decline in COPD patients. METHODS This was a cross-sectional study. A total of 401 COPD patients were included, and 190, 103, and 108 participants were included in non-smoking, cigarette-smoking, and sun-cured tobacco groups, respectively. We evaluated the global cognitive function using the Beijing version of the Montreal Cognitive Assessment, verbal fluency function using an animal fluency test, and memory function using ten unrelated words. RESULTS The participants of both cigarette-smoking (AOR=11.18; 95% CI: 1.28- 97.5) and sun-cured tobacco (AOR=10.46; 95% CI: 1.14-96.4) groups were more likely to develop mild cognitive impairment compared to the non-smoking group. The mean z scores of global cognitive function, verbal fluency, and memory were lower in cigarette-smoking and sun-cured tobacco groups than those in a non-smoking group; Multivariable linear regression showed that global cognitive function (β= -0.61; 95% CI: -1.04 - -0.18; and β= -0.48; 95% CI: -0.91 - -0.05) and verbal fluency (β= -0.79; 95% CI: -1.33 - -0.26; and β= -0.69; 95% CI: -1.23 - -0.16) of the sun-cured tobacco group and the cigarette-smoking group were significantly lower than those of the non-smoking group when adjusting for demographic and disease-related characteristics. However, there was no significant difference between the cigarette-smoking and sun-cured tobacco groups in global cognitive function, verbal fluency, and memory. CONCLUSIONS Compared with non-smokers, the use of cigarettes and sun-cured tobacco may damage the cognitive function of COPD patients, especially in global cognitive function and verbal fluency.
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Affiliation(s)
- Xiaomei Chen
- School of Nursing, Army Medical University, Chongqing, China
| | - Jie Li
- Department of Medicine, Qionglai Medical Center Hospital, Chengdu, China
| | - Jia Liu
- School of Nursing, Army Medical University, Chongqing, China
| | - Xiao Liu
- School of Nursing, Army Medical University, Chongqing, China
| | - Menghui Deng
- School of Nursing, Army Medical University, Chongqing, China
| | - Xunhu Dong
- Department of Chemical Defense Medicine, School of Military Preventive Medicine, Army Medical University, Chongqing, China
| | - Yanni Yang
- School of Nursing, Army Medical University, Chongqing, China
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Chen X, Dong X, Liu J, Liu X, Deng M, Yang Y. Rural-Urban Differences in Mild Cognitive Impairment Among Patients with Chronic Obstructive Pulmonary Disease in ChengDu, China. Int J Chron Obstruct Pulmon Dis 2023; 18:2497-2508. [PMID: 37965079 PMCID: PMC10642570 DOI: 10.2147/copd.s434743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
Purpose The rural-urban gap in sociodemographic, lifestyle, and disease-related characteristics among COPD patients is prevalent. These differences may influence the prevalence of mild cognitive impairment (MCI). This study aimed to compare the prevalence and determinants of MCI between rural and urban areas among COPD patients. Patients and Methods The cross-sectional study sample comprised 372 COPD patients from China. We evaluated the cognitive function and lung function, collected sociodemographic, lifestyle, and disease-related information, to compare the prevalence of MCI in rural and urban areas. Using multivariate regression analysis to examine the effects of variables to MCI. Results The prevalence of MCI in rural areas was higher than that in urban areas (65.4% vs 47.9%, P=0.001). The prevalence in farm laborers was almost twice as high as that of non-farm laborers in urban areas (82.6% vs 43.1%), but no significant difference in rural areas (P=0.066). However, the data were lower in subjects who insisted on long-term home oxygen therapy (39.7%, CI:27.8-51.6, P<0.001), and who with higher monthly household income (49.6%, CI:40.2-58.9) in rural areas, but no significant difference in urban areas (P=0.985 and 0.502). Multivariate logistic regression analysis indicated that participants aged 71 years and above, former smokers were at a high risk of MCI in both urban and rural areas. However, participants who slept for 6-8 hours a day, shopping frequently, or exercised for more than 2 hours a day had a lower risk of MCI in urban areas. But rural participants who insisted on long-term home oxygen therapy had a lower probability of developing MCI. Conclusion This study revealed that there were significant differences in MCI among COPD patients in rural and urban areas, especially in exercise, sleeping, shopping, and long-term home oxygen therapy. Medical staff should give health guidance according to the actual situation of patients with COPD.
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Affiliation(s)
- Xiaomei Chen
- School of Nursing, Army Medical University, Chongqing, People’s Republic of China
- Nursing Department, Qionglai Medical Center Hospital, Qionglai, Chengdu, People’s Republic of China
| | - Xunhu Dong
- School of Military Preventive Medicine, Army Medical University, Chongqing, People’s Republic of China
| | - Jia Liu
- School of Nursing, Army Medical University, Chongqing, People’s Republic of China
| | - Xiao Liu
- School of Nursing, Army Medical University, Chongqing, People’s Republic of China
| | - Menghui Deng
- School of Nursing, Army Medical University, Chongqing, People’s Republic of China
| | - Yanni Yang
- School of Nursing, Army Medical University, Chongqing, People’s Republic of China
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Hansen KK, Hilberg O, Jensen HI, Løkke A, Farver-Vestergaard I. The Association Between Cognitive Functions and Psychological Factors in Patients with Severe COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:2065-2078. [PMID: 37744734 PMCID: PMC10517680 DOI: 10.2147/copd.s426897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023] Open
Abstract
Purpose Patients with COPD experience anxiety, depression, and stress more frequently than in the age and gender-matched general population. This cross-sectional study aimed to examine the relationship between cognitive functions and the psychological factors of anxiety, depression and stress among patients with COPD. Patients and Methods Between January 2021 and January 2023, patients with severe COPD were recruited, along with age-matched controls. Participants completed the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS). The Montreal Cognitive Assessment (MoCA), a continuous reaction time test (CRT), and a driving simulator were used to assess cognitive impairment. Hierarchical multiple linear regression analyses were used to explain the variance of the correlations. Results In total, 80 patients (mean age = 64yrs) and 22 controls (mean age = 61yrs) participated in the study. Patients reported significantly higher levels of psychological symptoms compared to the controls (p ≤ 0.001). We found no differences in anxiety (p = 0.31), depression (p = 0.66) and stress (p = 0.37) between patients with and without cognitive impairment. However, stress showed to be a significant predictor of decreased attention (higher stress score resulted in decreasing CRT-index, indication a reduced stability in reaction time) (p = 0.02). Psychological factors did not explain additional variance in cognitive functions beyond sociodemographic factors such as age and sex. Conclusion Psychological symptom levels are higher in COPD than controls and perceived stress among patients with COPD appears to be associated with decreased attention. However, psychological factors in general did not appear to contribute to the variance in cognitive functions beyond sociodemographic, physical, and self-perceived symptoms.
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Affiliation(s)
- Kristina Kock Hansen
- Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ole Hilberg
- Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Irene Jensen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
| | - Anders Løkke
- Department of Respiratory Diseases, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ingeborg Farver-Vestergaard
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Lillebaelt Hospital, Vejle, University Hospital of Southern Denmark, Denmark
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Rassam P, Pazzianotto-Forti EM, Matsumura U, Orchanian-Cheff A, Aliabadi S, Kulkarni M, Fat Fur RL, Rodrigues A, Langer D, Rozenberg D, Reid WD. Impact of cognitive capacity on physical performance in chronic obstructive pulmonary disease patients: A scoping review. Chron Respir Dis 2023; 20:14799731231163874. [PMID: 37029090 PMCID: PMC10087654 DOI: 10.1177/14799731231163874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is often accompanied by impaired cognitive and physical function. However, the role of cognitive function on motor control and purposeful movement is not well studied. The aim of the review was to determine the impact of cognition on physical performance in COPD. Methods: Scoping review methods were performed including searches of the databases: MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane (CENTRAL), APA PsycINFO, and CINAHL. Two reviewers independently assessed articles for inclusion, data abstraction, and quality assessment. Results: Of 11,252 identified articles, 44 met the inclusion criteria. The review included 5743 individuals with COPD (68% male) with the forced expiratory volume in one second range of 24-69% predicted. Cognitive scores correlated with strength, balance, and hand dexterity, while 6-min walk distance (n = 9) was usually similar among COPD patients with and without cognitive impairment. In 2 reports, regression analyses showed that delayed recall and the trail making test were associated with balance and handgrip strength, respectively. Dual task studies (n = 5) reported impaired balance or gait in COPD patients compared to healthy adults. Cognitive or physical Interventions (n = 20) showed variable improvements in cognition and exercise capacity. Conclusions: Cognition in COPD appears to be more related to balance, hand, and dual task function, than exercise capacity.
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Affiliation(s)
- Peter Rassam
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
| | | | - Umi Matsumura
- Department of Health Sciences, Graduate School of Biomedical Sciences, 12961Nagasaki University, Nagasaki, Japan
| | - Ani Orchanian-Cheff
- Library and Information Services, 7989University Health Network, Toronto, ON, Canada
| | - Saina Aliabadi
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, 7989University Health Network, Toronto, ON, Canada
| | - Manjiri Kulkarni
- Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
| | | | - Antenor Rodrigues
- Department of Critical Care, St Michael's Hospital, Toronto, ON, Canada
| | - Daniel Langer
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, 26657Katholieke Universiteit Leuven, Leuven, Belgium
- Respiratory Rehabilitation and Respiratory Division, University Hospital Leuven, Leuven, Belgium
| | - Dmitry Rozenberg
- Division of Respirology, Temerty Faculty of Medicine, 7938University of Toronto, University Health Network, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, 7938University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabilitation Institute, 7989University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, 7938University of Toronto, Toronto, ON, Canada
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De Luca SN, Brassington K, Chan SMH, Dobric A, Mou K, Seow HJ, Vlahos R. Ebselen prevents cigarette smoke-induced cognitive dysfunction in mice by preserving hippocampal synaptophysin expression. J Neuroinflammation 2022; 19:72. [PMID: 35351173 PMCID: PMC8966248 DOI: 10.1186/s12974-022-02432-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Cigarette smoking (CS) is the leading cause of chronic obstructive pulmonary disease (COPD). The “spill-over” of pulmonary inflammation into the systemic circulation may damage the brain, leading to cognitive dysfunction. Cessation of CS can improve pulmonary and neurocognitive outcomes, however, its benefit on the neuroinflammatory profile remains uncertain. Here, we investigate how CS exposure impairs neurocognition and whether this can be reversed with CS cessation or an antioxidant treatment. Methods Male BALB/c mice were exposed to CS (9 cigarettes/day for 8 weeks) followed by 4 weeks of CS cessation. Another cohort of CS-exposed mice were co-administrated with a glutathione peroxidase mimetic, ebselen (10 mg/kg) or vehicle (5% CM-cellulose). We assessed pulmonary inflammation, spatial and working memory, and the hippocampal microglial, oxidative and synaptic profiles. Results CS exposure increased lung inflammation which was reduced following CS cessation. CS caused spatial and working memory impairments which were attributed to hippocampal microglial activation and suppression of synaptophysin. CS cessation did not improve memory deficits or alter microglial activation. Ebselen completely prevented the CS-induced working and spatial memory impairments, which was associated with restored synaptophysin expression without altering microglial activation. Conclusion We were able to model the CS-induced memory impairment and microglial activation seen in human COPD. The preventative effects of ebselen on memory impairment is likely to be dependent on a preserved synaptogenic profile. Cessation alone also appears to be insufficient in correcting the memory impairment, suggesting the importance of incorporating antioxidant therapy to help maximising the benefit of cessation.
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Dobric A, De Luca SN, Spencer SJ, Bozinovski S, Saling MM, McDonald CF, Vlahos R. Novel pharmacological strategies to treat cognitive dysfunction in chronic obstructive pulmonary disease. Pharmacol Ther 2021; 233:108017. [PMID: 34626675 DOI: 10.1016/j.pharmthera.2021.108017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and currently the 3rd largest cause of death in the world, with approximately 3.23 million deaths per year. Globally, the financial burden of COPD is approximately €82 billion per year and causes substantial morbidity and mortality. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities and viral and bacterial-induced acute exacerbations (AECOPD). Recent clinical studies have shown that cognitive dysfunction is present in up to 60% of people with COPD, with impairments in executive function, memory, and attention, impacting on important outcomes such as quality of life, hospitalisation and survival. The high prevalence of cognitive dysfunction in COPD may also help explain the insufficient adherence to therapeutic plans and strategies, thus worsening disease progression in people with COPD. However, the mechanisms underlying the impaired neuropathology and cognition in COPD remain largely unknown. In this review, we propose that the observed pulmonary oxidative burden and inflammatory response of people with COPD 'spills over' into the systemic circulation, resulting in damage to the brain and leading to cognitive dysfunction. As such, drugs targeting the lungs and comorbidities concurrently represent an exciting and unique therapeutic opportunity to treat COPD and cognitive impairments, which may lead to the production of novel targets to prevent and reverse the debilitating and life-threatening effects of cognitive dysfunction in COPD.
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Affiliation(s)
- Aleksandar Dobric
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Simone N De Luca
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Sarah J Spencer
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia; ARC Centre of Excellence for Nanoscale Biophotonics, RMIT University, Melbourne, VIC, Australia
| | - Steven Bozinovski
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Michael M Saling
- Clinical Neuropsychology, The University of Melbourne and Austin Health, VIC, Australia
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia; Department of Respiratory & Sleep Medicine, The University of Melbourne and Austin Health, Melbourne, VIC, Australia
| | - Ross Vlahos
- School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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