1
|
Almdabgy EM, Qader A, Binjahlan AA, Alshalawi AM, Albeladi A, Alharbi WS, Almehmadi KA. The Impact of Pulmonary Rehabilitation on Mental Health and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease (COPD): A Narrative Review. Cureus 2023; 15:e49230. [PMID: 38143627 PMCID: PMC10739906 DOI: 10.7759/cureus.49230] [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] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex, prevalent, debilitating, and degenerative disease that affects a large population, and the treatment options for the patients are limited. Although progress has been made in COPD pathogenesis, etiology, and management, there is still an unmet need to develop novel therapies. COPD management has recently seen a focus on a multidisciplinary pulmonary rehabilitation approach to help patients manage the disease better. This review primarily focuses on the role of pulmonary rehabilitation as a novel therapeutic strategy for treating and managing COPD, which is known to decrease patients' quality of life. Disease management and the beneficial effects of pulmonary rehabilitation in COPD are discussed. Subsequently, different methods that are employed in pulmonary rehabilitation are examined, including oxygen therapy, exercise, meditation, and education, emphasizing how they can help patients better manage COPD. Pathophysiology and the effect of pulmonary rehabilitation on the cellular level, such as the release of perforins and Th1 and Th17 cytokines, are also explored. The link between exercise and meditation during pulmonary rehabilitation therapy, which promotes repairing affected organs, is emphasized. Future perspectives on personalized medicine and its use in conjunction with pulmonary rehabilitation are also outlined. In conclusion, pulmonary rehabilitation holds significant promise for the management of COPD by addressing the present limitations of treatment. However, further research is essential to overcome and optimize treatment strategies for COPD patients.
Collapse
Affiliation(s)
- Elaf M Almdabgy
- Department of Internal Medicine, King Faisal Hospital, Makkah, SAU
| | - Ali Qader
- Department of Internal Medicine, Salmaniya Medical Complex, Manama, BHR
| | - Albandari A Binjahlan
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Alia M Alshalawi
- Department of Internal Medicine, King Abdulaziz Specialist Hospital, Taif, SAU
| | - Amani Albeladi
- Department of Internal Medicine, Umm Al-Qura University, Makkah, SAU
| | - Weaam S Alharbi
- Department of Internal Medicine, King Faisal Hospital, Makkah, SAU
| | | |
Collapse
|
2
|
Siraj RA. Comorbid Cognitive Impairment in Chronic Obstructive Pulmonary Disease (COPD): Current Understanding, Risk Factors, Implications for Clinical Practice, and Suggested Interventions. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040732. [PMID: 37109690 PMCID: PMC10146750 DOI: 10.3390/medicina59040732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
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.
Collapse
Affiliation(s)
- Rayan A Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Eastus CC, Baez DE, Buckley ML, Lee J, Adami A. The role of structured exercise interventions on cognitive function in older individuals with stable Chronic Obstructive Pulmonary Disease: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:987356. [PMID: 36386775 PMCID: PMC9659625 DOI: 10.3389/fresc.2022.987356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/29/2022] [Indexed: 01/24/2023]
Abstract
UNLABELLED A decline in cognitive performance has been associated with disease severity, exacerbations rate, presence of comorbidities, and low activity level in people with chronic obstructive pulmonary disease (COPD). Participation in exercise programs appears to have neuroprotective effects and to improve cognitive performance in older people. The present work undertook a scoping review of the effects of exercise-based interventions on cognitive function in older individuals with stable COPD. METHODS The methodological framework for scoping review was used and electronic searches of five databases performed. Original research and observational studies published between January 2010 and December 2021, administering exercise-based interventions and cognitive function evaluation, were included. RESULTS Of 13 full-text manuscripts assessed for eligibility, five were allocated to analysis. Three studies administered exercise training within pulmonary outpatient rehabilitation program (PR), and one inpatient PR. The fifth study conducted a structured training intervention in which either aerobic or a combination with resistance exercises were included. Twelve cognitive function screening tools were used in the five studies included in the analysis. Results extracted were based on 245 COPD (33% female) with moderate to very-severe airflow limitation. Interventions ranged from 12 to 36 sessions. Studies reported statistically significant improvements after intervention in different cognitive function domains, such as global cognition, immediate and delayed recall ability, cognitive flexibility, verbal fluency, attention, abstract reasoning, praxis ability. CONCLUSIONS Exercise-based interventions improve several areas of cognitive function in patients with stable COPD. However, the magnitude of gain varies among studies, and this is possibly due to the heterogeneity of tests used. Future research is needed to validate the optimal battery of screening tests, and to support the definition of guidelines for cognitive function evaluation in COPD.
Collapse
Affiliation(s)
- Caroline C. Eastus
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Daniel E. Baez
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States
| | - Maria L. Buckley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jungeun Lee
- College of Nursing, University of Rhode Island, Kingston, RI, United States
| | - Alessandra Adami
- Department of Kinesiology, College of Health Sciences, University of Rhode Island, Kingston, RI, United States,Correspondence: Alessandra Adami
| |
Collapse
|
5
|
Zeng F, Hong W, Zha R, Li Y, Jin C, Liu Y, Liu H, Liu M, Liu M, Xu F, Hu D, Song H, Wu H, Yu Y, Zhang X. Smoking related attention alteration in chronic obstructive pulmonary disease-smoking comorbidity. BMC Pulm Med 2022; 22:182. [PMID: 35524207 PMCID: PMC9078025 DOI: 10.1186/s12890-022-01964-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a respiratory disease that causes a wide range of cognitive impairments. Although COPD-Smoking comorbidity is common, the relationship between smoking and cognitive function in COPD-Smoking comorbidity remains unclear. This study aimed to investigate the effect of smoking on cognitive function like attention in COPD-Smoking patients. Methods In this study, we used the Montreal Cognitive Assessment (MoCA) scale and resting-state functional magnetic resonance imaging (fMRI) to explore the effect of smoking on attention in patients with COPD. Results Behavioral analysis revealed that among patients with COPD the smokers had a shorter course of COPD and showed a worse attention performance than the non-smokers. Resting-state fMRI analysis revealed that among patients with COPD smokers showed lower regional homogeneity (ReHo) value of the fusiform gyrus than non-smokers. Importantly, the ReHo of the fusiform gyrus is positively associated with attention and mediates the effect of smoking on attention in COPD. Conclusions In summary, our study provides behavioral and neurobiological evidence supporting the positive effect of smoking on attention in COPD. This may be helpful for understanding and treating COPD and even other diseases comorbid with smoking. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01964-6.
Collapse
Affiliation(s)
- Feiyan Zeng
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Wei Hong
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Rujing Zha
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China.
| | - Ying Li
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Chen Jin
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Ying Liu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Hao Liu
- School of Earth and Space Science, University of Science & Technology of China, Hefei, 230027, China
| | - Mengqiu Liu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Mei Liu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Fei Xu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Daiju Hu
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Hongwen Song
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China
| | - Haiyan Wu
- Centre for Cognitive and Brain Sciences (CCBS), University of Macau (UM), Macau SAR, China
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
| | - Xiaochu Zhang
- Department of Radiology, the First Affiliated Hospital of USTC, Department of Psychology, School of Humanities & Social Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, 230027, China. .,Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, 230031, China. .,Hefei Medical Research Center on Alcohol Addiction, Affiliated Psychological Hospital of Anhui Medical University, Hefei Fourth People's Hospital, Anhui Mental Health Center, Hefei, 230017, China. .,Biomedical Sciences and Health Laboratory of Anhui Province, University of Science & Technology of China, Hefei, 230027, China.
| |
Collapse
|
6
|
Roncero C, Pérez J, Molina J, Quintano JA, Campuzano AI, Pérez J, Miravitlles M. Frequency and Associated Factors of Suicidal Ideation in Patients with Chronic Obstructive Pulmonary Disease. J Clin Med 2022; 11:jcm11092558. [PMID: 35566685 PMCID: PMC9101437 DOI: 10.3390/jcm11092558] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
We aimed to examine the prevalence of suicidal ideation in patients with chronic obstructive pulmonary disease (COPD) and the association between demographic and clinical variables and the occurrence of suicidal thoughts. This was a cross-sectional study. Sociodemographic and clinical data were recorded, and questionnaires were used to assess depressive symptoms (Beck Depression Inventory), comorbidities (Charlson Index), cognitive performance (Mini Mental State Examination), and quality of life (EuroQoL-5 dimensions and CAT). Specific questions about suicide-related behavior were included. Multivariate logistic regression analysis identified the significant factors associated with previous suicidal ideation and suicide attempts. The analysis included 1190 subjects. The prevalence of suicidal ideation and suicide attempts were 12.1% and 2.5%, respectively. Severely depressed patients had the highest prevalence of suicide-related behavior. The adjusted logistic model identified factors significantly associated with suicidal ideation: sex (odds ratio (OR) for women vs. men = 2.722 (95% confidence interval (CI) = 1.771–4.183)), depression score (OR = 1.163 (95% IC = 1.127–1.200)), and Charlson Index (OR 1.228 (95% IC 1.082–1.394)). Suicidal ideation is common in COPD patients, especially in women. While addressing suicidal ideation and suicide prevention, clinicians should first consider the management of depressive symptomatology and the improvement of coping strategies.
Collapse
Affiliation(s)
- Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
- Correspondence: (C.R.); (M.M.)
| | - Joselín Pérez
- Medical Department, Grupo Ferrer, 08029 Barcelona, Spain; (J.P.); (A.I.C.)
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, 28993 Madrid, Spain;
| | | | | | - Javier Pérez
- Psychiatric Service, University of Salamanca Health Care Complex, 37007 Salamanca, Spain;
- Institute of Biomedicine of Salamanca (IBSAL), University of Salamanca, 37007 Salamanca, Spain
| | - Marc Miravitlles
- Department of Pneumology, Vall d’Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
- Correspondence: (C.R.); (M.M.)
| |
Collapse
|
7
|
van Beers M, Mount SW, Houben K, Gosker HR, Schuurman L, Franssen FM, Janssen DJ, Schols AM. Working memory training efficacy in COPD: the randomised, double-blind, placebo-controlled Cogtrain trial. ERJ Open Res 2021; 7:00475-2021. [PMID: 34853784 PMCID: PMC8628195 DOI: 10.1183/23120541.00475-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cognitive impairment is highly prevalent in COPD and is associated with a sedentary lifestyle, unhealthy diet and increased cognitive stress susceptibility. Enhancement of cognitive performance by working memory training (WMT) may reverse these effects. Therefore, this study aimed to investigate the efficacy of WMT in COPD on cognitive performance, healthy lifestyle behaviours and cognitive stress susceptibility. METHODS The double-blind randomised, placebo-controlled Cogtrain trial consisted of a 12-week training phase comprising 30 active or sham WMT sessions, followed by a second 12-week maintenance phase with 12 sessions. Measurements took place at baseline and after the first and second phases. The primary outcome was cognitive performance. Secondary outcomes were the recall of prespecified healthy lifestyle goals, physical capacity and activity, dietary quality and cognitive stress susceptibility. Motivation towards exercising and healthy eating and psychological wellbeing were exploratory outcomes. RESULTS Sixty-four patients with moderate COPD (45% male, aged 66.2±7.2 years, median forced expiratory volume in 1 s 60.6% predicted) were randomised. WMT significantly increased patients' performance on the trained tasks in the first phase, which remained stable in the second phase. Of the 17 cognitive outcome measures, only one measure of memory improved after the first phase and one measure of reaction time after the second phase. This intervention did not influence physical capacity and activity, recall of prespecified healthy lifestyle goals, psychological wellbeing or cognitive stress susceptibility. CONCLUSION WMT improved performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD.
Collapse
Affiliation(s)
- Martijn van Beers
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sarah W. Mount
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Katrijn Houben
- Dept of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Harry R. Gosker
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lisanne Schuurman
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frits M.E. Franssen
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Dept of Research and Education, CIRO, Horn, The Netherlands
| | - Daisy J.A. Janssen
- Dept of Research and Education, CIRO, Horn, The Netherlands
- Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Annemie M.W.J. Schols
- Dept of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
8
|
Zacarias LC, Câmara KJDC, Alves BM, Morano MTAP, Viana CMS, Mont'Alverne DGB, Castro SS, Leite CF. Validation of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with COPD. Disabil Rehabil 2021; 44:5663-5668. [PMID: 34261374 DOI: 10.1080/09638288.2021.1948117] [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: 10/20/2022]
Abstract
PURPOSE COPD fits the profile of disabling health conditions. This study aims to validate the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in individuals with COPD. MATERIAL AND METHODS 100 participants with COPD responded to the Brazilian 36-item version of the WHODAS 2.0, as well as the Saint George's Respiratory Questionnaire (SGRQ), and the COPD Assessment Test (CAT). Spirometric data was extracted from medical records. RESULTS The internal consistency analysis showed coefficients for all WHODAS 2.0 domains with a strong correlation (0.70-0.85) except for Life activities, which had a moderate correlation (coefficient = 0.60). In the construct analysis, the coefficients for the WHODAS and SGRQ domains presented a consistent correlation among them, varying from 0.40 to 0.69. No correlation was evidenced among the WHODAS domains and the spirometric data, highlighting that linear measures fail when associated with the functioning of an individual with COPD. Discriminative analysis revealed a capacity for the WHODAS 2.0 to distinguish among COPD different levels of clinical impact obtained from CAT excluding the Getting along domain. CONCLUSION The WHODAS 2.0 shows as a valid instrument that can sensibly assess functioning differences related to the clinical impact classification level in subjects with COPD.IMPLICATIONS FOR REHABILITATIONWHODAS 2.0 is a valid tool to assess functioning in subjects with COPD.WHODAS 2.0 is sensitive to functioning differences related to classification level and to clinical impact in individuals with COPD.As a Patient-Reported Outcome Measure (PROM), WHODAS 2.0 offers the opportunity to develop clinical patient-centered interventions, improving the health care.As a low-cost, easy-to-use tool, WHODAS can be a useful resource in the process of clinical assessment of patient functioning.
Collapse
Affiliation(s)
- Laíla Cândida Zacarias
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Brazil
| | | | | | | | | | | | - Shamyr Sulyvan Castro
- Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Brazil
| | - Camila Ferreira Leite
- Graduate Program in Cardiovascular Sciences, Federal University of Ceara, Fortaleza, Brazil.,Master Program in Physiotherapy and Functioning, Federal University of Ceara, Fortaleza, Brazil
| |
Collapse
|
9
|
Allen B, Aboussouan LS. Diagnostic and therapeutic challenges of chronic obstructive pulmonary disease in the elderly. Curr Opin Pulm Med 2021; 27:113-119. [PMID: 33332880 DOI: 10.1097/mcp.0000000000000750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) imposes a large burden on the global population and even more so for the elderly who face significant obstacles in the diagnosis, management, and psychosocial effects of the disease. This review describes the current challenges and key points in the management of COPD in the elderly. RECENT FINDINGS Lower limit rather than fixed cut off of the FEV1/FVC ratio can improve the diagnosis and better predict COPD mortality. High relative to standard dose influenza vaccination reduces confirmed cases of influenza overall and reduces hospitalizations in older nursing home residents. Simple interventions that include electronic health record tracking can significantly improve vaccination rates. Although many inhaler and nebulized medications are available for the elderly, the final regimen is usually determined by a combination of expense, issues with proper device use (from difficulty with coordination, hand grip, inspiratory flows or cognitive function) and the side effect profile. Fortunately, the switch to cheaper or better covered alternatives can be well tolerated with improvement in adherence and exacerbations of COPD. Finally, caution should be made against ageism, which may be a factor in the recommendation of rehabilitation or palliative care in the elderly COPD patient, as both are underused despite evidence of benefit. SUMMARY Although care for the elderly COPD patient can be difficult, we summarize key points that the physician should be cognizant of to provide comprehensive care.
Collapse
Affiliation(s)
- Brian Allen
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | |
Collapse
|
10
|
van Beers M, Gosker HR, Janssen DJA, Cleutjens FAHM, Franssen FME, van Boxtel MPJ, Wouters EF, Ponds RWHM, Schols AMWJ. Cognitive performance in relation to metabolic disturbances in patients with COPD. Clin Nutr 2020; 40:2061-2067. [PMID: 33041090 DOI: 10.1016/j.clnu.2020.09.029] [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: 04/28/2020] [Revised: 08/18/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
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.
Collapse
Affiliation(s)
- Martijn van Beers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6202 AZ Maastricht, the Netherlands.
| | - Harry R Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6202 AZ Maastricht, the Netherlands
| | - Daisy J A Janssen
- Department of Research and Development, CIRO, P.O. Box 4009, 6080 AA Haelen, the Netherlands; Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6202 AZ Maastricht, the Netherlands
| | - Fiona A H M Cleutjens
- Department of Research and Development, CIRO, P.O. Box 4009, 6080 AA Haelen, the Netherlands
| | - Frits M E Franssen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6202 AZ Maastricht, the Netherlands; Department of Research and Development, CIRO, P.O. Box 4009, 6080 AA Haelen, the Netherlands
| | - Martin P J van Boxtel
- Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, 6202 AZ Maastricht, the Netherlands
| | - Emiel F Wouters
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6202 AZ Maastricht, the Netherlands; Department of Research and Development, CIRO, P.O. Box 4009, 6080 AA Haelen, the Netherlands
| | - Rudolf W H M Ponds
- Department of Psychiatry and Neuropsychology and Limburg Brain Injury Center, School for Mental Health and Neurosciences, Maastricht University, 6202 AZ Maastricht, the Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6202 AZ Maastricht, the Netherlands
| |
Collapse
|
11
|
Zhang XL, Gao B, Han T, Xiang BY, Liu X. Moderate-to-Severe Obstructive Sleep Apnea and Cognitive Function Impairment in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:1813-1822. [PMID: 32801679 PMCID: PMC7396955 DOI: 10.2147/copd.s257796] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose Prior studies have indicated that patients with chronic obstructive pulmonary disease (COPD) exhibit significant cognitive defects on neuropsychological testing. Obstructive sleep apnea (OSA) is common in patients with COPD and is associated with reduced cognitive function; however, the combined impact of these two conditions on cognitive function is unknown. The aim of the study was to investigate the impact of OSA on cognitive impairment in patients with COPD. Methods Sixty-five stable COPD patients aged over 60 years underwent overnight polysomnography (PSG). Global cognitive functions were evaluated using the Mini-Mental State Examination (MMSE). Results Compared to patients with COPD alone, patients with both COPD and OSA performed worse on the MMSE (25.5±2.9 vs 23.5±3.2; p=0.01) and were more likely to be at risk for developing dementia based on the MMSE score (MMSE≤24) (31% vs 66%; p<0.01), independent of key demographic, educational and medical variables known to affect cognitive function in COPD. COPD patients with an apnea hypopnea index (AHI) of ≥30 events/h had lower MMSE scores than those with an AHI of <15 events/h. In addition to age and education level, the severity of nocturnal intermittent hypoxia is an independent predictor of the risk of dementia in patients with COPD (OR=1.24, 95% CI 1.04-1.48, p = 0.02). Conclusion The current findings indicate that patients with COPD with comorbid OSA may be at greater risk for global cognitive impairment relative to patients with COPD alone. The mechanisms underlying the exaggerated cognitive dysfunction seem to be related to intermittent hypoxia. Further work is needed to understand the impact of OSA on the specific domains of cognitive impairment and the therapeutic implications of OSA in COPD.
Collapse
Affiliation(s)
- Xiao Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China.,Capital Medical University, Beijing, People's Republic of China.,The Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China.,Peking University Health Science Center, Beijing, People's Republic of China
| | - Bo Gao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China.,Capital Medical University, Beijing, People's Republic of China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Bo Yun Xiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| | - Xin Liu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, People's Republic of China.,National Clinical Research Center for Respiratory Diseases, Beijing, People's Republic of China
| |
Collapse
|
12
|
Bonnevie T, Medrinal C, Combret Y, Debeaumont D, Lamia B, Muir JF, Cuvelier A, Prieur G, Gravier FE. Mid-Term Effects of Pulmonary Rehabilitation on Cognitive Function in People with Severe Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:1111-1121. [PMID: 32546999 PMCID: PMC7245438 DOI: 10.2147/copd.s249409] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Cognitive dysfunction is a common impairment associated with COPD. However, little is known about 1) its prevalence among those subjects referred for pulmonary rehabilitation (PR), 2) how it may affect the benefit of PR, 3) whether PR improves cognitive function and 4) whether cognitive dysfunction affects the usability of telehealth technology usually used to deliver in-home PR. Patients and Methods Fifty-six subjects with stable COPD (54% females, mean age 62 years (SD 9) and median FEV1 0.9 L (IQR 0.7 to 1.1)) participated in this multicenter observational study and performed 24 sessions of PR. The Montreal Cognitive Assessment tool (MoCA) was used to assess the occurrence of mild cognitive dysfunction (using a screening cutoff <26) at baseline, completion of PR and 3 months of follow-up. Results Mild cognitive dysfunction was found in 41 subjects (73% [95% CI: 60 to 83%]). The MoCA score significantly improved following PR for those people with baseline mild cognitive dysfunction (p<0.01). There was no significant difference in clinical outcomes between those people with or without mild cognitive dysfunction following PR nor in the proportion of subjects who were autonomous in using the telemonitoring system (83% compared with 71%, p=0.60). Conclusion Mild cognitive dysfunction is highly prevalent among those people with COPD referred for PR but does not affect the benefits of PR nor the usability of a telemonitoring system. PR may improve short- and mid-term cognitive function for those people who experience mild cognitive dysfunction at the time they are referred to PR.
Collapse
Affiliation(s)
- Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Clement Medrinal
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Department, Le Havre Hospital, Le Havre, France
| | - Yann Combret
- Physiotherapy Department, Le Havre Hospital, Le Havre, France.,Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium
| | - David Debeaumont
- Department of Respiratory and Exercise Physiology and CIC-CRB 1404, Rouen University Hospital, Rouen, France
| | - Bouchra Lamia
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Department, Le Havre Hospital, Le Havre, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Guillaume Prieur
- Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Intensive Care Unit Department, Le Havre Hospital, Le Havre, France.,Institute of Experimental and Clinical Research (IREC), Pole of Pulmonology, ORL and Dermatology, Catholic University of Louvain, Brussels, Belgium
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France.,Normandy University UNIROUEN, UPRES EA 3830, Haute Normandie Research and Biomedical Innovation, Rouen, France
| |
Collapse
|
13
|
Frailty as a Predictor of Mortality in Patients With Interstitial Lung Disease Referred for Lung Transplantation. Transplantation 2020; 104:864-872. [DOI: 10.1097/tp.0000000000002901] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
Luo CS, Chi CC, Fang YA, Liu JC, Lee KY. Influenza vaccination reduces dementia in patients with chronic obstructive pulmonary disease: a nationwide cohort study. J Investig Med 2020; 68:838-845. [PMID: 31941664 DOI: 10.1136/jim-2019-001155] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2019] [Indexed: 01/25/2023]
Abstract
This study aimed to explore the protective potential of influenza vaccination against occurrence of dementia in patients with chronic obstructive pulmonary disease (COPD), who are expected to be more vulnerable to influenza infection. This nationwide retrospective cohort study enrolled patients with COPD (aged ≥60 years) from 1 January 2001 to 31 December 2012 by using the Taiwan National Health Insurance Research Database. By applying time-dependent Cox proportional hazard model, we used multivariate analysis to calculate the adjusted HR (aHR) with 95% CI of dementia in relation to influenza vaccination among patients with COPD. Besides, patients were partitioned into four groups according to the vaccination number (unvaccinated, 1, 2-3 and ≥4 total vaccinations) to investigate the dose-response effect of vaccinations on the dementia incidence. This cohort study included 19 848 patients with COPD, and 45% of them received influenza vaccination. The aHR of dementia was 0.68 (95% CI: 0.62 to 0.74, p<0.001) comparing vaccinated patients with unvaccinated ones. Furthermore, there was a trend of dementia risk reduction with the vaccination number. For patients who received 2-3 vaccinations, the aHR was 0.81 (95% CI: 0.73 to 0.90), and for those received 4 vaccinations, the aHR was 0.44 (95% CI: 0.40 to 0.50), with p for trend <0.001. In conclusion, annual influenza vaccination can reduce the risk of dementia in patient with COPD in a dose-dependent manner.
Collapse
Affiliation(s)
- Ching-Shan Luo
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Ann Fang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ju-Chi Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan .,Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kang-Yun Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan .,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
15
|
Huang TH, Chen CZ, Kuo HI, Er HP, Lin SH. Enhanced risk of traumatic brain injury in patients with chronic obstructive pulmonary disease. J Investig Med 2020; 68:846-855. [PMID: 31892639 PMCID: PMC7231432 DOI: 10.1136/jim-2019-001207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 11/17/2022]
Abstract
This study tests our hypothesis that patients with chronic obstructive pulmonary disease (COPD) have an increased risk of traumatic brain injury (TBI). In this nationwide retrospective cohort study, we used a subset of Taiwan’s National Health Insurance Research Database, involving 1 million randomly selected beneficiaries. Patients with newly diagnosed COPD between 2000 and 2008 were identified. They were subgrouped as ‘COPDAE+’ (if they had severe acute exacerbation of COPD during the follow-ups) or ‘COPDAE−’ (if they had no acute exacerbation), and were frequency matched with randomly selected subjects without COPD (the ‘non-COPD’ group). Baseline differences were balanced by the inverse probability of treatment weighting based on the propensity score. For each patient, the risk of TBI during the subsequent 5 years was determined. The competing risk of death was controlled. We identified 3734 patients in ‘COPDAE+’, and frequency matched them with 11,202 patients in ‘COPDAE−’ and 11,202 subjects in ‘non-COPD’. Compared with those in ‘non-COPD’, patients in ‘COPDAE+’ and ‘COPDAE−’ had an increased risk of TBI: the adjusted HR for ‘COPDAE+’ was 1.50, 95% CI 1.31 to 1.73, and that for ‘COPDAE−’ was 1.21, 95% CI 1.09 to 1.34. The highest risk was observed in the ‘COPDAE+’ group that aged <65 (the adjusted HR was 1.92; 95% CI 1.39 to 2.64). COPD has been linked to complications beyond the respiratory system. In this study we showed that COPD is associated with an increased risk of TBI.
Collapse
Affiliation(s)
- Tang-Hsiu Huang
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Zuei Chen
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-I Kuo
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hong-Ping Er
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan .,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
16
|
Cheung YT, Brinkman TM, Li C, Mzayek Y, Srivastava D, Ness KK, Patel SK, Howell RM, Oeffinger KC, Robison LL, Armstrong GT, Krull KR. Chronic Health Conditions and Neurocognitive Function in Aging Survivors of Childhood Cancer: A Report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2019; 110:411-419. [PMID: 29088360 DOI: 10.1093/jnci/djx224] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/20/2017] [Indexed: 11/12/2022] Open
Abstract
Background Neurocognitive impairment in survivors of childhood cancer may be associated with direct neurotoxicity, as well as indirect effects of systemic health complications. We evaluated associations among treatment exposures, chronic health conditions, and neurocognitive outcomes in adult survivors of childhood cancer. Methods Participants included 5507 adult survivors of childhood cancer (47.1% male; mean [SD] age = 31.8 [7.6] years at evaluation; 23.1 [4.5] years postdiagnosis) in the Childhood Cancer Survivor Study who completed a self-report measure of neurocognitive function. Cardiac, pulmonary, and endocrine chronic health conditions were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Structural equation modeling was used to examine a priori hypothesized causal pathways among cancer treatment, subsequent chronic health conditions, and neurocognitive outcomes. Multivariable models were used to estimate relative risk for associations of treatments and chronic conditions on neurocognitive function. All statistical tests were two-sided. Results One-third of survivors with a grade 2 or higher chronic condition reported impairments in task efficiency and memory. In addition to direct effects of cranial radiation, path analyses and multivariable models demonstrated direct effects of cardiopulmonary (β = 0.10, P = .002; relative risk [RR] = 1.27, 95% confidence interval [CI] = 1.12 to 1.44) and endocrine (β = 0.07, P = .04; RR = 1.14, 95% CI = 1.02 to 1.28) conditions on impaired task efficiency. We identified similar effects of cardiopulmonary condition on memory (P = .01) and emotional regulation (P = .01). Thoracic radiation was associated with impaired task efficiency (P = .01) and emotional regulation (P = .01) through endocrine morbidity. Conclusions Non-neurotoxic exposures, such as thoracic radiation, can adversely impact survivors' neurocognitive function through chronic conditions. Management of chronic diseases may mitigate neurocognitive outcomes among aging survivors of childhood cancer.
Collapse
Affiliation(s)
- Yin Ting Cheung
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Tara M Brinkman
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Chenghong Li
- Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Yasmin Mzayek
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Deokumar Srivastava
- Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K Ness
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Sunita K Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA
| | - Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Leslie L Robison
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Gregory T Armstrong
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Kevin R Krull
- Departments of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN.,Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| |
Collapse
|
17
|
Effects of health literacy and cognitive abilities on COPD self-management behaviors: A prospective cohort study. Respir Med 2019; 160:105630. [PMID: 30850277 DOI: 10.1016/j.rmed.2019.02.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/05/2019] [Accepted: 02/07/2019] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Low rates of adherence to self-management behaviors are common among patients with COPD. Health literacy and cognitive abilities may influence engagement in self-management behaviors. We sought to assess the association between health literacy and cognitive abilities with self-management behaviors in patients with COPD. METHODS We conducted an observational cohort study among American adults with COPD in New York, New York, and Chicago, Illinois. Outcomes included adherence to COPD medication, metered dose inhaler (MDI) and dry powder inhaler (DPI) technique, receipt of vaccination, and routine healthcare appointments. Health literacy was measured with the Short Test of Functional Health Literacy in Adults. Cognitive function was assessed in terms of global, fluid (working memory, processing speed, executive function) and crystallized (verbal) ability. RESULTS Adequate health literacy was associated with adequate adherence to COPD medications (OR 1.46; 95% CI, 1.02-2.08), correct MDI (OR 1.66; 95% CI, 1.13-2.44) and DPI (OR 2.17; 95% CI, 1.30-3.64) technique. Fluid abilities were also associated with medication behaviors and visiting a regular healthcare provider, while crystalized abilities were not. Global cognitive abilities were associated with correct inhaler technique. No other associations were found with non-medication self-management behaviors. CONCLUSIONS COPD patients with limited health literacy and deficits in fluid cognitive abilities have lower rates of adherence and poorer inhaler technique than individuals with adequate health literacy and greater fluid cognitive abilities. These findings highlight the importance of considering the health literacy level and cognitive ability when caring for and educating patients with COPD.
Collapse
|
18
|
Tudorache V, Traila D, Marc M, Oancea C, Manolescu D, Tudorache E, Timar B, Albai A, Fira-Mladinescu O. Impact of moderate to severe obstructive sleep apnea on the cognition in idiopathic pulmonary fibrosis. PLoS One 2019; 14:e0211455. [PMID: 30707735 PMCID: PMC6358087 DOI: 10.1371/journal.pone.0211455] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive lung disease with a fatal prognosis to whose rapid evolution multiple comorbidities may contribute, one of the most common being obstructive sleep apnea (OSA). There are several potential factors and conditions for the emergence of a cognitive deficit in relation to IPF or associated morbidities. Objectives The goals of this study were to assess cognition in patients with IPF in stable phase and to identify clinical cognition modifiers. Methods In a cross-sectional study, 23 patients with IPF were evaluated using Montreal Cognitive Assessment (MoCA), an instrument for detecting mild cognitive impairments and were screened for OSA through overnight cardiorespiratory polygraphy and for anxiety and depression with three specific scale (Generalized Anxiety Disorder 7-item scale: GAD-7; the Patient Health Questionnaire: PHQ-9; Hospital Anxiety and Depression Scale: HADS). Results MoCA score was lower in patients with IPF when compared to controls subjects (24 [21,26] vs. 27 [26,28], p = 0.003) but not as significantly as in COPD patients (21 [18.8,23.3], p<0.0001). OSA was diagnosed in 19 (82.6%) IPF patients, 12 patients showed the presence of moderate-severe forms (63.15%). IPF patients with cognitive impairment (MoCA<23) exhibit a higher severity of OSA (apneea hypopnea index–AHI: 33.0±19.1 vs. 12.44±8.2, p = 0.018), and a higher Epworth score (7.1±3.3 vs. 4.3±1.8, p = 0.013). Anxiety and depression scores were not correlated with MoCA results. Conclusions Impaired cognition in patients with IPF is mild and affect the areas of visuospatial abilities, language and working memory. OSA could be a possible predictor of IPF cognition deficit. Given the high prevalence of multiple types of sleep disorders in IPF patients, these should be investigated at least by cardiorespiratory polygraphy.
Collapse
Affiliation(s)
- Voicu Tudorache
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Daniel Traila
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
- * E-mail:
| | - Monica Marc
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Diana Manolescu
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Bogdan Timar
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alin Albai
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
| |
Collapse
|
19
|
Mei L, Wu S, Wang D, Li H, Zhang H, Wang M. Epidemiology of Dementia in Elderly Chronic Obstructive Pulmonary Disease Patients Living in China's Northwestern High-Elevation Area. Med Sci Monit 2018; 24:7742-7749. [PMID: 30372705 PMCID: PMC6217287 DOI: 10.12659/msm.909501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The aim of this study was to investigate the effects of oxygen and cholinesterase inhibitor (donepezil) therapy on dementia in patients with age-exacerbated chronic obstructive pulmonary disease (COPD) in China’s northwestern high-altitude area. Material/Methods A total of 145 patients with acute exacerbation of COPD admitted to the Gerontology Department of the First People’s Hospital of Xining City were initially retrospectively screened. From among these 145 patients, we selected 33 cases with dementia and 33 patients without dementia through use of the Mini-Mental State Examination (MMSE), the Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and Activities of Daily Living (ADL) Scale evaluated before, 7 days after, and at the end of the treatment after 3 months. Both patient groups received oxygen therapy for 7 days, but patients with dementia in the intervention group were medicated additionally with donepezil (5 mg/day for 1 week, followed by 10 mg/day for another 12 weeks). Results Mild dementia was found in 35 of the 145 COPD patients. ADL, MMSE, and ADAS-Cog scores were all significantly lower in the intervention group before treatment, improved after the first 7 days, and continued to improve significantly until week 12 in the intervention group, but were still significantly lower than in the control group. Conclusions Dementia in elderly COPD patients was mainly manifested as decreased executive function, attention, language, and delayed recall, while oxygen and donepezil therapy had beneficial effects on the symptoms.
Collapse
Affiliation(s)
- Li Mei
- Department of Geriatrics, Xining No.1 People's Hospital, Xining, Qinghai, China (mainland)
| | - Shizheng Wu
- Department of Neurology, Qinghai Provincial People's Hospital, Xining, Qinghai, China (mainland)
| | - Dongchao Wang
- Department of Orthopedics, Xining No. 1 People's Hospital, Xining, Qinghai, China (mainland)
| | - Hezhou Li
- Department of Neurosurgery, Xining No. 1 People's Hospital, Xining, Qinghai, China (mainland)
| | - Hongmei Zhang
- Department of Geriatrics, Xining No. 1 People's Hospital, Xining, Qinghai, China (mainland)
| | - Min Wang
- Department of Geriatrics, Xining No. 1 People's Hospital, Xining, Qinghai, China (mainland)
| |
Collapse
|
20
|
Pelgrim CE, Peterson JD, Gosker HR, Schols AMWJ, van Helvoort A, Garssen J, Folkerts G, Kraneveld AD. Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both? Eur J Pharmacol 2018; 842:99-110. [PMID: 30336140 DOI: 10.1016/j.ejphar.2018.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Charlotte E Pelgrim
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Julia D Peterson
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Harry R Gosker
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Annemie M W J Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands
| | - Ardy van Helvoort
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Department of Respiratory Medicine, Maastricht, the Netherlands; Nutrition, Metabolism and Muscle Sciences, Nutricia Research, Utrecht, the Netherlands
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Platform Immunology, Nutricia Research, Utrecht, the Netherlands
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Aletta D Kraneveld
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands; Veterinary Pharmacology & Therapeutics, Institute of Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands.
| |
Collapse
|
21
|
van Beers M, Janssen DJA, Gosker HR, Schols AMWJ. Cognitive impairment in chronic obstructive pulmonary disease: disease burden, determinants and possible future interventions. Expert Rev Respir Med 2018; 12:1061-1074. [DOI: 10.1080/17476348.2018.1533405] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Martijn van Beers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Daisy J. A. Janssen
- Department of Research & Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Centre of Expertise for Palliative Care, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| |
Collapse
|
22
|
Chronic Obstructive Pulmonary Disease Education in Pulmonary Rehabilitation. An Official American Thoracic Society/Thoracic Society of Australia and New Zealand/Canadian Thoracic Society/British Thoracic Society Workshop Report. Ann Am Thorac Soc 2018; 15:769-784. [DOI: 10.1513/annalsats.201804-253ws] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Miravitlles M, Molina J, Quintano JA, Campuzano A, Pérez J, Roncero C. Depressive status explains a significant amount of the variance in COPD assessment test (CAT) scores. Int J Chron Obstruct Pulmon Dis 2018; 13:823-831. [PMID: 29563782 PMCID: PMC5846753 DOI: 10.2147/copd.s154791] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background COPD assessment test (CAT) is a short, easy-to-complete health status tool that has been incorporated into the multidimensional assessment of COPD in order to guide therapy; therefore, it is important to understand the factors determining CAT scores. Methods This is a post hoc analysis of a cross-sectional, observational study conducted in respiratory medicine departments and primary care centers in Spain with the aim of identifying the factors determining CAT scores, focusing particularly on the cognitive status measured by the Mini-Mental State Examination (MMSE) and levels of depression measured by the short Beck Depression Inventory (BDI). Results A total of 684 COPD patients were analyzed; 84.1% were men, the mean age of patients was 68.7 years, and the mean forced expiratory volume in 1 second (%) was 55.1%. Mean CAT score was 21.8. CAT scores correlated with the MMSE score (Pearson's coefficient r=-0.371) and the BDI (r=0.620), both p<0.001. In the multivariate analysis, the usual COPD severity variables (age, dyspnea, lung function, and comorbidity) together with MMSE and BDI scores were significantly associated with CAT scores and explained 45% of the variability. However, a model including only MMSE and BDI scores explained up to 40% and BDI alone explained 38% of the CAT variance. Conclusion CAT scores are associated with clinical variables of severity of COPD. However, cognitive status and, in particular, the level of depression explain a larger percentage of the variance in the CAT scores than the usual COPD clinical severity variables.
Collapse
Affiliation(s)
- Marc Miravitlles
- Department of Pneumology, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Madrid, Spain
| | | | | | | | - Carlos Roncero
- Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain
| | | |
Collapse
|
24
|
Poortinga W, Rodgers SE, Lyons RA, Anderson P, Tweed C, Grey C, Jiang S, Johnson R, Watkins A, Winfield TG. The health impacts of energy performance investments in low-income areas: a mixed-methods approach. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.ObjectivesTo determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.DesignA mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.SettingLow-income areas across Wales.ParticipantsResidents who received energy efficiency measures through the intervention programme and matched control groups.Main outcome measuresPrimary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.MethodsAnonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.Data sourcesThe Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.ResultsThe study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.LimitationsThis was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.ConclusionAlthough there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.Future workOur research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.FundingThe National Institute for Health Research Public Health Research programme.
Collapse
Affiliation(s)
| | - Sarah E Rodgers
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Chris Tweed
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Charlotte Grey
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Shiyu Jiang
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Rhodri Johnson
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Thomas G Winfield
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| |
Collapse
|
25
|
Koroukian SM, Schiltz NK, Warner DF, Stange KC, Smyth KA. Increasing Burden of Complex Multimorbidity Across Gradients of Cognitive Impairment. Am J Alzheimers Dis Other Demen 2017; 32:408-417. [PMID: 28871795 PMCID: PMC10852662 DOI: 10.1177/1533317517726388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study evaluates the burden of multimorbidity (MM) across gradients of cognitive impairment (CI). METHODS Using data from the 2010 Health and Retirement Study, we identified individuals with no CI, mild CI, and moderate/severe CI. In addition, we adopted an expansive definition of complex MM by accounting for the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes. RESULTS In a sample of 18 913 participants (weighted n = 87.5 million), 1.93% and 1.84% presented with mild and moderate/severe CI, respectively. The prevalence of most conditions constituting complex MM increased markedly across the spectrum of CI. Further, the percentage of individuals presenting with 10 or more conditions was 19.9%, 39.3%, and 71.3% among those with no CI, mild CI, and moderate/severe CI, respectively. DISCUSSION Greater CI is strongly associated with increased burden of complex MM. Detailed characterization of MM across CI gradients will help identify opportunities for health care improvement.
Collapse
Affiliation(s)
- Siran M. Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - Nicholas K. Schiltz
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Cleveland, OH, USA
| | - David F. Warner
- Department of Sociology, University of Nebraska–Lincoln, Lincoln, NE, USA
| | - Kurt C. Stange
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kathleen A. Smyth
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
26
|
Aras YG, Tunç A, Güngen BD, Güngen AC, Aydemir Y, Demiyürek BE. The effects of depression, anxiety and sleep disturbances on cognitive impairment in patients with chronic obstructive pulmonary disease. Cogn Neurodyn 2017; 11:565-571. [PMID: 29147148 DOI: 10.1007/s11571-017-9449-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 07/08/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022] Open
Abstract
The purpose of this study was to investigate the effects of depression, anxiety and sleep disturbances on cognitive functions in chronic obstructive pulmonary disease (COPD) patients. In this prospective case-control study, demographic data, smoking history, depression, anxiety, sleep quality and cognitive status of 48 COPD patients and 36 healthy volunteers aged 40-90 years were recorded. The Beck depression inventory (BDI), the Beck anxiety inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression, anxiety and sleep quality, respectively in COPD patients. Cognitive performance was studied by the mini-mental state examination. The mean age of patients with COPD was 65.3 ± 9.4 years, and disease duration was 9.6 ± 7.8 years. Male sex ratio, smoking, BDI score, BAI score, total PSQI score, sleep latency, sleep duration, average use of sleep aids and sleep disturbances in patients with COPD were significantly higher than the control group (p < 0.05). When cognitive impairment was compared by age, FVC, FEV, FEV/FVC, PEF values and smoking, no statistically significant relationship was found (p > 0.05). A statistically significant relationship was established between cognitive impairment and severity of disease, presence of anxiety, presence of depression and sleep quality. In our study, we found that sleep disorders, depression and anxiety comorbid with COPD increased cognitive impairment as well as the severity of disease. We believe that this finding is important in terms of reducing the risk of cognitive impairment, preventing misdiagnosis and treatment of the aforementioned comorbid diseases.
Collapse
Affiliation(s)
- Yesim Güzey Aras
- Department of Neurology, Research and Training Hospital, Sakarya University, 54100 Adapazarı, Sakarya Turkey
| | - Abdülkadir Tunç
- Department of Neurology, Bezmi Alem Vakıf University, İstanbul, İstanbul Turkey
| | - Belma Doğan Güngen
- Department of Neurology, Research and Training Hospital, Sakarya University, 54100 Adapazarı, Sakarya Turkey
| | - Adil Can Güngen
- Department of Pulmonology, Research and Training Hospital, Sakarya University, Adapazarı, Sakarya Turkey
| | - Yusuf Aydemir
- Department of Pulmonology, Research and Training Hospital, Sakarya University, Adapazarı, Sakarya Turkey
| | - Bekir Enes Demiyürek
- Department of Neurology, Research and Training Hospital, Sakarya University, 54100 Adapazarı, Sakarya Turkey
| |
Collapse
|
27
|
Cleutjens FAHM, Spruit MA, Ponds RWHM, Vanfleteren LEGW, Franssen FME, Gijsen C, Dijkstra JB, Wouters EFM, Janssen DJA. Cognitive impairment and clinical characteristics in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2017; 15:91-102. [PMID: 28553720 PMCID: PMC5958463 DOI: 10.1177/1479972317709651] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We aimed to investigate (1) the relationship between cognitive impairment (CI) and
disease severity and (2) the potential differences in exercise performance, daily
activities, health status, and psychological well-being between patients with and without
CI. Clinically stable chronic obstructive pulmonary disease (COPD) patients, referred for
pulmonary rehabilitation, underwent a neuropsychological examination. Functional exercise
capacity (6-minute walk test [6MWT]), daily activities (Canadian Occupational Performance
Measure [COPM]), health status (COPD Assessment Test [CAT]) and St George’s Respiratory
Questionnaire-COPD specific [SGRQ-C]), and psychological well-being (Hospital Anxiety and
Depression Scale [HADS], Beck Depression Inventory [BDI], and Symptom Checklist 90
[SCL-90]) were compared between patients with and without CI. Of 183 COPD patients (mean
age 63.6 (9.4) years, FEV1 54.8 (23.0%) predicted), 76 (41.5%) patients had CI.
The prevalence was comparable across Global Initiative for Chronic Obstructive Lung
Disease (GOLD) grades 1–4 (44.8%, 40.0%, 41.0%, 43.5%, respectively, p =
0.97) and GOLD groups A–D (50.0%, 44.7%, 33.3%, 40.2%, respectively, p =
0.91). Patients with and without CI were comparable for demographics, smoking status,
FEV1% predicted, mMRC, 6MWT, COPM, CAT, HADS, BDI, and SCL-90 scores.
Clinical characteristics of COPD patients with and without CI are comparable. Assessment
of CI in COPD, thus, requires an active case-finding approach.
Collapse
Affiliation(s)
- Fiona A H M Cleutjens
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Martijn A Spruit
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Rudolf W H M Ponds
- 3 Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands
| | - Lowie E G W Vanfleteren
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Frits M E Franssen
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Candy Gijsen
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Jeanette B Dijkstra
- 3 Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands
| | - Emiel F M Wouters
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands.,4 Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Daisy J A Janssen
- 1 Department of Research and Education, CIRO, Centre of expertise for chronic organ failure, Horn, the Netherlands
| |
Collapse
|
28
|
Thyregod M, Bodtger U. Coherence between self-reported and objectively measured physical activity in patients with chronic obstructive lung disease: a systematic review. Int J Chron Obstruct Pulmon Dis 2016; 11:2931-2938. [PMID: 27932873 PMCID: PMC5135064 DOI: 10.2147/copd.s116422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The beneficial effects of physical activity (PA) in patients with COPD, as well as the methods of their assessment, are well known and described. As objective measures of PA, such as the use of motion sensors, video recordings, exercise capacity testing, and indirect calorimetry, are not easily obtained in the daily clinical life, the reliability of the more accessible self-reported measurements of PA is important. In this review, we systematically identified original studies involving COPD patients and at least one parameter of self-reported and objective exercise testing, and analyzed every article for coherence between the objectively and self-reported measured PA. The studies are few, small, and very diverse, both in their use of questionnaires and objective measurements. Self-reported assessments were found to generally overestimate the level of PA compared to measurements made objectively by activity monitors; however, more studies are needed to rely solely on the use of PA questionnaires in COPD patients. The most accurate and valid questionnaires appear to be the self-completed Physical Activity Scale for the Elderly and the interviewer-completed Stanford Seven-Day Physical Activity Recall Questionnaire, but the ideal questionnaire still awaits construction. The motion sensors are accurate and validated in this patient group, especially SenseWear™, but not easily accessible in clinical practice, as they have various technical and adhesive difficulties.
Collapse
Affiliation(s)
- Mimi Thyregod
- Department of Respiratory Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine, Naestved Hospital, Naestved; Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|