1
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Buican IL, Gheorman V, Udriştoiu I, Olteanu M, Rădulescu D, Calafeteanu DM, Nemeş AF, Călăraşu C, Rădulescu PM, Streba CT. Interactions between Cognitive, Affective, and Respiratory Profiles in Chronic Respiratory Disorders: A Cluster Analysis Approach. Diagnostics (Basel) 2024; 14:1153. [PMID: 38893678 PMCID: PMC11171769 DOI: 10.3390/diagnostics14111153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
This study conducted at Leamna Pulmonology Hospital investigated the interrelations among cognitive, affective, and respiratory variables within a cohort of 100 patients diagnosed with chronic respiratory conditions, utilizing sophisticated machine learning-based clustering techniques. Spanning from October 2022 to February 2023, hospitalized individuals confirmed to have asthma or COPD underwent extensive evaluations using standardized instruments such as the mMRC scale, the CAT test, and spirometry. Complementary cognitive and affective assessments were performed employing the MMSE, MoCA, and the Hamilton Anxiety and Depression Scale, furnishing a holistic view of patient health statuses. The analysis delineated three distinct clusters: Moderate Cognitive Respiratory, Severe Cognitive Respiratory, and Stable Cognitive Respiratory, each characterized by unique profiles that underscore the necessity for tailored therapeutic strategies. These clusters exhibited significant correlations between the severity of respiratory symptoms and their effects on cognitive and affective conditions. The results highlight the benefits of an integrated treatment approach for COPD and asthma, which is personalized based on the intricate patterns identified through clustering. Such a strategy promises to enhance the management of these diseases, potentially elevating the quality of life and everyday functionality of the patients. These findings advocate for treatment customization according to the specific interplays among cognitive, affective, and respiratory dimensions, presenting substantial prospects for clinical advancement and pioneering new avenues for research in the domain of chronic respiratory disease management.
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Affiliation(s)
- Iulian-Laurențiu Buican
- U.M.F. Doctoral School Craiova, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Leamna Pulmonology Hospital, 207129 Leamna, Romania; (C.C.); (P.-M.R.); (C.-T.S.)
| | - Victor Gheorman
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (I.U.)
| | - Ion Udriştoiu
- Department of Psychiatry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (V.G.); (I.U.)
| | - Mădălina Olteanu
- Department of Orthodontics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Dumitru Rădulescu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania
| | - Dan Marian Calafeteanu
- Department of Surgery, The Military Emergency Clinical Hospital ‘Dr. Stefan Odobleja’ Craiova, 200749 Craiova, Romania
| | - Alexandra Floriana Nemeş
- Department of Neonatology, ‘Louis Ţurcanu’ Clinical Emergency Hospital for Children, 300011 Timişoara, Romania;
| | - Cristina Călăraşu
- Leamna Pulmonology Hospital, 207129 Leamna, Romania; (C.C.); (P.-M.R.); (C.-T.S.)
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Costin-Teodor Streba
- Leamna Pulmonology Hospital, 207129 Leamna, Romania; (C.C.); (P.-M.R.); (C.-T.S.)
- Department of Pulmonology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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2
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Zailani H, Satyanarayanan SK, Liao WC, Hsu YT, Huang SY, Gałecki P, Su KP, Chang JPC. Roles of Omega-3 Polyunsaturated Fatty Acids in Managing Cognitive Impairment in Chronic Obstructive Pulmonary Disease: A Review. Nutrients 2023; 15:4363. [PMID: 37892438 PMCID: PMC10609799 DOI: 10.3390/nu15204363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) contributes significantly to the death of people worldwide, especially the elderly. An essential feature of COPD is pulmonary inflammation, which results from long-term exposure to noxious substances from cigarette smoking and other environmental pollutants. Pulmonary inflammatory mediators spill over to the blood, leading to systemic inflammation, which is believed to play a significant role in the onset of a host of comorbidities associated with COPD. A substantial comorbidity of concern in COPD patients that is often overlooked in COPD management is cognitive impairment. The exact pathophysiology of cognitive impairment in COPD patients remains a mystery; however, hypoxia, oxidative stress, systemic inflammation, and cerebral manifestations of these conditions are believed to play crucial roles. Furthermore, the use of medications to treat cognitive impairment symptomatology in COPD patients has been reported to be associated with life-threatening adverse effects, hence the need for alternative medications with reduced side effects. In this Review, we aim to discuss the impact of cognitive impairment in COPD management and the potential mechanisms associated with increased risk of cognitive impairment in COPD patients. The promising roles of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in improving cognitive deficits in COPD patients are also discussed. Interestingly, ω-3 PUFAs can potentially enhance the cognitive impairment symptomatology associated with COPD because they can modulate inflammatory processes, activate the antioxidant defence system, and promote amyloid-beta clearance from the brain. Thus, clinical studies are crucial to assess the efficacy of ω-3 PUFAs in managing cognitive impairment in COPD patients.
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Grants
- MOST 109-2320-B-038-057-MY3, 109-2320-B-039-066, 110-2321-B-006-004, 111-2321-B-006-008, 110-2811-B-039-507, 110-2320-B-039-048-MY2, and 110-2320-B-039-047-MY3, 110-2813-C-039-327-B, 110-2314-B-039-029-MY3, 111-2314-B-039-041-MY3 Ministry of Science and Technology, Taiwan
- ANHRF 109-31, 109-40, 110-13, 110-26, 110-44, 110-45, 111-27, and 111-28 An-Nan Hospital, China Medical University, Tainan, Taiwan
- CMRC-CMA-2 Higher Education Sprout Project by the Ministry of Education (MOE), Taiwan
- CMU 110-AWARD-02, CMU108-SR-106, CMU110-N-17, CMU110-SR-73 China Medical University, Taichung, Taiwan
- CRS-108-048, DMR-105-053, DMR-109-102, DMR-109-244, DMR-HHC-109-11, DMR-HHC-109-12, DMR-HHC-110-10, DMR-110-124, DMR-111-245 and DMR-HHC-111-8 China Medical University Hospital, Taichung, Taiwan
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Affiliation(s)
- Halliru Zailani
- Mind-Body Interface Laboratory (MBI-Lab), Department of Psychiatry, China Medical University Hospital, Taichung 404327, Taiwan; (H.Z.); (S.K.S.)
- Graduate Institute of Nutrition, China Medical University, Taichung 404, Taiwan
- Department of Biochemistry, Ahmadu Bello University, Zaria 810106, Nigeria
| | - Senthil Kumaran Satyanarayanan
- Mind-Body Interface Laboratory (MBI-Lab), Department of Psychiatry, China Medical University Hospital, Taichung 404327, Taiwan; (H.Z.); (S.K.S.)
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404327, Taiwan
| | - Yi-Ting Hsu
- Department of Neurology, China Medical University Hospital, Taichung 404327, Taiwan;
| | - Shih-Yi Huang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 11031, Taiwan
- Nutrition Research Centre, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Piotr Gałecki
- Department of Adult Psychiatry, Medical University of Lodz, 91-229 Lodz, Poland;
| | - Kuan-Pin Su
- Mind-Body Interface Laboratory (MBI-Lab), Department of Psychiatry, China Medical University Hospital, Taichung 404327, Taiwan; (H.Z.); (S.K.S.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
- An-Nan Hospital, China Medical University, Tainan 717, Taiwan
| | - Jane Pei-Chen Chang
- Mind-Body Interface Laboratory (MBI-Lab), Department of Psychiatry, China Medical University Hospital, Taichung 404327, Taiwan; (H.Z.); (S.K.S.)
- College of Medicine, China Medical University, Taichung 404, Taiwan
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3
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Ogawa M, Uchiumi A, Sato S, Hamakawa Y, Kobashi M, Aoyama T, Tanimukai H. Preliminary study of assessing cognitive impairment in older patients with chronic obstructive pulmonary disease by using a cognitive functional assessment tool via a touchscreen personal computer. Multidiscip Respir Med 2023; 18:892. [PMID: 36798953 PMCID: PMC9926919 DOI: 10.4081/mrm.2023.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/16/2022] [Indexed: 02/04/2023] Open
Abstract
Background Unique cognitive impairments related to chronic obstructive pulmonary diseases (COPD) have been increasingly reported. Considering the dementia risk and medication management, older patients with COPD should be evaluated for cognitive impairment. This study aimed to examine whether specific cognitive impairments related to COPD could be detected by an assessment tool using a touchscreen personal computer (PC) in older patients with COPD. Methods This study included 28 older male patients with COPD and 30 healthy older male individuals. A touchscreen PC-based cognitive assessment application called CogEvo was used to assess and compare the cognitive function according to five domains: spatial cognition, orientation, working memory, executive function, and attention. Results Analysis of variance showed an interaction effect on the indices of cognitive function based on five domains between the two groups, indicating differences in the characteristics of cognitive function in such groups. Betweengroup comparisons as a subtest showed that attention, executive function, and working memory were significantly lower in the COPD group than in the healthy group. Conclusions CogEvo can detect specific cognitive impairments associated with COPD, suggesting that it can be potentially used as a screening tool for cognitive impairment in older patients with COPD.
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Affiliation(s)
- Masahiro Ogawa
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto ,* Present address: Faculty of Rehabilitation, Kobe Gakuin University, Kobe
| | - Ayame Uchiumi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto ,§Present address: Procurement Department, Hitachi High-Tech Corporation, Hitachinaka
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto ,Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto
| | - Yoko Hamakawa
- Department of Respiratory Medicine, Kitano Hospital, Osaka
| | - Mizuki Kobashi
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto ,^Present address: Department of Rehabilitation, Kyoto Hakuaikai Hospital, Kyoto, Japan
| | - Tomoki Aoyama
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto
| | - Hitoshi Tanimukai
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto ,Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
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4
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Le WD, Yang C, Yang Q, Xiang Y, Zeng XR, Xiao J. The neuroprotective effects of oxygen therapy in Alzheimer’s disease: a narrative review. Neural Regen Res 2023. [PMID: 35799509 PMCID: PMC9241400 DOI: 10.4103/1673-5374.343897] [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: 11/20/2022] Open
Abstract
Alzheimer’s disease (AD) is a degenerative neurological disease that primarily affects the elderly. Drug therapy is the main strategy for AD treatment, but current treatments suffer from poor efficacy and a number of side effects. Non-drug therapy is attracting more attention and may be a better strategy for treatment of AD. Hypoxia is one of the important factors that contribute to the pathogenesis of AD. Multiple cellular processes synergistically promote hypoxia, including aging, hypertension, diabetes, hypoxia/obstructive sleep apnea, obesity, and traumatic brain injury. Increasing evidence has shown that hypoxia may affect multiple pathological aspects of AD, such as amyloid-beta metabolism, tau phosphorylation, autophagy, neuroinflammation, oxidative stress, endoplasmic reticulum stress, and mitochondrial and synaptic dysfunction. Treatments targeting hypoxia may delay or mitigate the progression of AD. Numerous studies have shown that oxygen therapy could improve the risk factors and clinical symptoms of AD. Increasing evidence also suggests that oxygen therapy may improve many pathological aspects of AD including amyloid-beta metabolism, tau phosphorylation, neuroinflammation, neuronal apoptosis, oxidative stress, neurotrophic factors, mitochondrial function, cerebral blood volume, and protein synthesis. In this review, we summarized the effects of oxygen therapy on AD pathogenesis and the mechanisms underlying these alterations. We expect that this review can benefit future clinical applications and therapy strategies on oxygen therapy for AD.
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Annaka H, Nomura T, Moriyama H. Cognitive Function and the Ability to Operate Long-Term Oxygen Therapy Equipment: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10708. [PMID: 36078424 PMCID: PMC9517874 DOI: 10.3390/ijerph191710708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Chronic respiratory disease patients with severe hypoxia receive long-term oxygen therapy (LTOT). The proper operation of LTOT equipment is essential for continuing treatment. This exploratory study investigated the relationship between cognitive impairment as a comorbidity in patients receiving LTOT and their ability to operate the LTOT equipment. The study measured responses to questions based on the ability of participants to operate the equipment and applied the Montreal Cognitive Assessment (MoCA). The ability of groups with MoCA scores ≤ 25 and >25 to operate LTOT equipment was compared to confirm the correlation between MoCA and ability to operate the equipment. An aggregate of 60 participants receiving LTOT were recruited, of whom 45 (75%) were MoCA score ≤ 25. The group of MoCA score ≤ 25 demonstrated a lower ability to operate LTOT equipment than group of MoCA score > 25 (p = 0.012). Additionally, a correlation was found between the ability to operate LTOT equipment and MoCA (rs = 0.743, p < 0.001). The results indicated that the group of MoCA score ≤ 25 indicated a lower ability to operate LTOT equipment than that of MoCA score > 25. Cognitive impairment in patients receiving LTOT can affect their ability to operate LTOT equipment.
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Affiliation(s)
- Hiroki Annaka
- Department of Occupational Therapy, National Hospital Organization Nishiniigata Chuo Hospital, Niigata 950-2085, Japan
- Graduate School, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Tomonori Nomura
- Department of Occupational Therapy, Faculty of Rehabilitation, Niigata University of Health and Welfare, Niigata 950-3198, Japan
| | - Hiroshi Moriyama
- Respiratory Center, National Hospital Organization Nishiniigata Chuo Hospital, Niigata 950-2085, Japan
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6
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Sedentary Time and Cognitive Impairment in Patients Using Long-Term Oxygen Therapy: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031726. [PMID: 35162749 PMCID: PMC8835276 DOI: 10.3390/ijerph19031726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/17/2022]
Abstract
Physical inactivity is a predictor of death in patients with chronic respiratory disease. Cognitive impairment is common among patients with chronic respiratory disease. However, the association between sedentary time and cognitive impairment in patients with chronic respiratory disease using long-term oxygen therapy is unclear. This study aimed to determine the relationship between sedentary time and cognitive impairment in patients on long-term oxygen therapy. This cross-sectional study included 96 patients with chronic respiratory disease on long-term oxygen therapy (mean age 77.3 years; female, 22%). The primary outcomes measured were sedentary time (Japanese version of the International Physical Activity Questionnaire Short Form), cognitive function (Montreal Cognitive Assessment), and dyspnea (modified Medical Research Council scale). The factors associated with sedentary time were confirmed by multiple regression analysis. The median sedentary time was 600.0 min. The median Montreal Cognitive Assessment score was 24.0 points, and 67 (70%) patients had mild cognitive impairment. In multiple regression analysis, sedentary time was associated with dyspnea (β = 0.397, p < 0.001) and cognitive function (β = −0.239, p = 0.020). This study indicates that sedentary time in patients on long-term oxygen therapy was associated with dyspnea and cognitive impairment.
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7
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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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Barata PI, Marc MS, Tudorache E, Frandes M, Crisan AF, Olar DC, Oancea C. Self-reported sleep disturbance and mild cognitive impairment in COPD patients with severe airflow limitation. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:808-814. [PMID: 33749073 DOI: 10.1111/crj.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/11/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION COPD has multiple extrapulmonary manifestations and the latest studies have focused on cognitive dysfunction effects on sleep quality. The purpose of this study is to assess if there is a relationship between sleep quality and cognitive decline in COPD patients with severe airflow limitation. METHODS We performed an observational study to determine if there is a link between cognitive function and sleep quality. The included patients were divided into two groups: a group with COPD patients and control group. We evaluated lung volumes, cognitive function, sleep quality and disease impact on the quality of life. RESULTS Most of the COPD patients presented mild cognitive impairment (MCI) (95.7%), compared with only 24.1% in the control group (Pearson chi-square χ2 (1) = 42.560, p < 0.001). We observed that all the COPD patients were poor sleepers, while only 13.8% of the control patients presented a poor sleep (Pearson chi-square χ2 (1) = 60.379, p < 0.001). We observed that poor sleep was significantly associated with MCI (OR = 9.200; 95% CI = 3.656-23.153; p < 0.001). At the same time, when considering only the COPD patients with moderate disease impact, poor sleep was also a risk factor for MCI (OR = 1.210; 95% CI = 1.016-1.440; p < 0.001). CONCLUSION COPD patients with severe airflow limitation report a high prevalence of poor sleep quality and cognitive function. We observed a significant association between cognitive function and sleep quality.
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Affiliation(s)
- Paula Irina Barata
- Faculty of Medicine, Department of Physiology, "Vasile Goldis" University of Arad, Arad, Romania
| | - Monica Steluta Marc
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Mirela Frandes
- Department of Biostatistics and Medical Informatics, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Alexandru Florian Crisan
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
| | - Dana Cristina Olar
- Faculty of Medicine, Department of Physiology, "Vasile Goldis" University of Arad, Arad, Romania
| | - Cristian Oancea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Timisoara, Romania
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9
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Huang Y, Ma J, Jiang B, Yang N, Fu F, Chen X, Liu C, Miao X, Mao H, Zheng R, Wang J, Ding K, Zhang X. Effect of nutritional risk on cognitive function in patients with chronic obstructive pulmonary disease. J Int Med Res 2021; 49:300060521990127. [PMID: 33535842 PMCID: PMC7869158 DOI: 10.1177/0300060521990127] [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] [Indexed: 12/31/2022] Open
Abstract
Objective We aimed to clarify the cognitive function of patients with chronic obstructive pulmonary disease (COPD) and different nutritional status. Methods Among 95 patients with COPD in this retrospective study, we administered the Nutritional Risk Screening 2002 (NRS 2002) and Mini-Mental State Examination (MMSE). We recorded patients’ clinical characteristics, comorbidities, and laboratory measurements. According to NRS 2002 scores, patients were divided into two groups: no nutritional risk with NRS 2002 < 3 (n = 54) and nutritional risk, with NRS 2002 ≥ 3 (n = 41). Results We found a negative correlation between NRS 2002 and MMSE scores in participants with COPD (r = −0.313). Patients with nutritional risk were more likely to be cognitively impaired than those with no nutritional risk. Multivariate logistic regression analysis indicated that malnutrition was an independent risk factor for cognitive impairment, after adjusting for confounders (odds ratio [OR] = 4.120, 95% confidence interval [CI]: 1.072–15.837). We found a similar association between NRS 2002 and MMSE scores at 90-day follow-up using a Pearson’s correlation test (r = −0.493) and logistic regression analysis (OR = 7.333, 95% CI: 1.114–48.264). Conclusions Patients with COPD at nutritional risk are more likely to have cognitive impairment.
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Affiliation(s)
- Yiben Huang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiedong Ma
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Bingqian Jiang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Naiping Yang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Fangyi Fu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xianjing Chen
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chunyan Liu
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaqi Miao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Huanhuan Mao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Rongrong Zheng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Jianing Wang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Keke Ding
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Xiaodiao Zhang
- Department of Respiratory Medicine, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Yohannes AM, N Eakin M, Holbrook JT, Sugar EA, Henderson R, Baker AM, Casper AS, Kaminsky DA, Rea AL, Mathews AM, Que LG, Ramsdell JW, Gerald LB, Wise RA, Hanania NA. Association of mild cognitive impairment and characteristic of COPD and overall health status in a cohort study. Expert Rev Respir Med 2020; 15:153-159. [PMID: 33054443 DOI: 10.1080/17476348.2021.1838278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Introduction: We evaluated risk factors and demographic characteristics of associated with mild cognitive impairment (MCI) in patients with COPD. Methods: 220 individuals with COPD enrolled in a cohort study designed to evaluate anxiety conducted at 16 clinical centers. Cognitive impairment was assessed with the Montreal Cognitive Assessment (MoCA), a cutoff score of <26 defined as MCI. Data were collected including spirometry, 6-minute walk test, symptom burden by COPD Assessment Test and dyspnea by Modified Medical Research Council, anxiety measured by Anxiety Inventory of Respiratory Disease, Generalized Anxiety Disorder-7 and Hospital Anxiety Depression Scale, depression by Patient Health Questionnaire-9 and health status by Patient Reported Outcomes Measurement Information System and sleep quality by the Pittsburg Sleep Quality Index. Results: The median age was 65 years and 54% of participants were male. 119(54%) of participants had MCI as classified by MoCA. In multivariable logistic regression, higher odds ratios (OR) (95% confidence interval) for MCI (MoCA) <26 were associated with increased years of age, 1.06 (1.02 -1-09, p<0.003); African-American race, 3.68(1.67-8.11, p<0.001); persistent phlegm, 2 (1.12-3.57, p<0.01) and sleep disturbance, 1.04(1.01-1.08, p<0.01). Conclusions: COPD patients commonly screen positive for MCI. Characteristics associated with MCI included age, African-American race, sleep disturbance and persistent phlegm.
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Affiliation(s)
- Abebaw M Yohannes
- Department of Physical Therapy, School of Behavioral and Applied Sciences, Azusa Pacific University , Azusa, United States
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Janet T Holbrook
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | | | - Robert Henderson
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | - Anna M Baker
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Anne S Casper
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | - David A Kaminsky
- Section of Pulmonary Medicine, University of Vermont Larner College of Medicine , Burlington, United States
| | - Alexis L Rea
- Johns Hopkins Bloomberg School of Public Health , Baltimore, USA
| | - Anne M Mathews
- Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine Pulmonary Division , Durham, USA
| | - Loretta G Que
- Pulmonary, Allergy and Critical Care Medicine, Duke University School of Medicine Pulmonary Division , Durham, USA
| | - Joe W Ramsdell
- Division of Internal Medicine, The University of California San Diego , San Diego, USA
| | - Lynn B Gerald
- Department of Asthma and Airway Disease Research Center, Mel & Enid Zuckerman College of Public Health and the Asthma and Airway Disease Research Center, the University of Arizona , Tucson, USA
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine , Baltimore, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine , Houston, United States
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11
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Mermit Çilingir B, Günbatar H, Çilingir V. Cognitive dysfunction among patients in chronic obstructive pulmonary disease: Effects of exacerbation and long-term oxygen therapy. THE CLINICAL RESPIRATORY JOURNAL 2020; 14:1137-1143. [PMID: 32772486 DOI: 10.1111/crj.13250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND We investigated the association between cognitive dysfunction (CD) and chronic obstructive pulmonary disease (COPD) during exacerbation and compare with stable COPD patients and control subjects. Also, we compared the cognitive function of long-term oxygen therapy (LTOT) dependent patients and not receiving LTOT. METHODS The 121 people included in the study. They were divided into three groups: exacerbation of COPD (COPD-E), stable COPD (COPD-S) and control groups. Also, COPD patients were divided into two groups, non-user LTOTD-COPD and regular-user LTOTD-COPD. The patients were asked in their native language by exact conversion of the questions of MMSE (Mini Mental State Examination). RESULTS The mean age of patients was 67 and ratio of patients with MMSE results below 24 was 41.6%. MMSE score was 18.9 in patient with exacerbation and 25.7 in stable COPD. Age average was higher and MMSE was lower in COPD-E group. Low educational degree was predicting factor for CD in COPD-E group. Low MMSE was related with decreased FEV1%, pO2 and sO2 values, increased pCO2 values, low educational level and increased comorbidity. MMSE score was 18.8 in reguler-user LTOTD COPD and 24.9 in nonuser LTOTD-COPD. Regular-user LTOTD-COPD groups exacerbation rate was higher than nonuser LTOTD-COPD group. CONCLUSION MMSE scores was low in COPD-E group and regular-user LTOTD-COPD group. This is important because MMSE identifies clinically significant CD. This suggests that the CD may be linked to the causes of severe exacerbations. Clinicians need to look for CD, because cognitive function needs to be taken into account in their management of the patient.
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Affiliation(s)
- Buket Mermit Çilingir
- Faculty of Medicine, Department of Chest Diseases, Yuzuncu Yil University, Van, Turkey
| | - Hülya Günbatar
- Faculty of Medicine, Department of Chest Diseases, Yuzuncu Yil University, Van, Turkey
| | - Vedat Çilingir
- Faculty of Medicine, Department of Neurology, Yuzuncu Yil University, Van, Turkey
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12
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Changes in Spatial Working Memory in Stable Chronic Obstructive Pulmonary Disease: A Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7363712. [PMID: 32775438 PMCID: PMC7396050 DOI: 10.1155/2020/7363712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 12/02/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and is often accompanied by cognitive impairment. Little is known about the working memory of COPD patients. The aim of the study is to evaluate the spatial working memory of COPD patients using the classical visuospatial working memory neuropsychological paradigms. This was a retrospective study of patients with COPD who were evaluated for neurocognitive functions between February and December 2018 at Hefei Second People's Hospital. Healthy controls (HC) were included. The neuropsychological tests included the Beijing Version of the Montreal Cognitive Assessment Test (MoCA), digit span test (DS), Chinese Auditory Verbal Learning Test (CAVLT), Stroop test, and Verbal Fluency Test (VFT). The COPD group performed worse in MoCA (22.3 ± 4.5 vs. 26.1 ± 2.9, P < 0.001), Stroop interference test (44.2 ± 16.9 vs. 36.8 ± 10.3, P = 0.038), and VFT (12.9 ± 2.8 vs. 15.3 ± 4.7, P = 0.021) vs. the HC group. Compared with the HC group, COPD patients had statistically significant differences with respect to 0-back RT (657 ± 46 vs. 578 ± 107, P = 0.001), 1-back accuracy (41.8 ± 12.1% vs. 81.5 ± 18.1%, P < 0.001), 1-back RT (592 ± 75 vs. 431 ± 138, P < 0.001), 2-back accuracy (31.4 ± 9.9% vs. 68.1 ± 16.6%, P < 0.001), and 2-back RT (563 ± 79 vs. 455 ± 153, P = 0.002). Only PaO2 was independently associated with 0-back RT (B = 0.992 ± 0.428, P = 0.028) and 1-back ACC (B = 0.003 ± 0.001, P = 0.004). COPD patients exhibit impairment in working memory and executive function, but not in short- or long-term memory. The impairment of working memory in a patient with COPD may be more due to integrate memory information rather than to memory information storage. COPD patients exhibit a frontal-type cognitive decline.
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13
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Hassan SA, Campos MA, Kasawara KT, Bonetti LV, Patterson KK, Beal DS, Fregonezi GAF, Stanbrook MB, Reid WD. Changes in Oxyhemoglobin Concentration in the Prefrontal Cortex during Cognitive-Motor Dual Tasks in People with Chronic Obstructive Pulmonary Disease. COPD 2020; 17:289-296. [PMID: 32441147 DOI: 10.1080/15412555.2020.1767561] [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] [Indexed: 10/24/2022]
Abstract
Cognitive and motor impairment are well documented in chronic obstructive pulmonary disease (COPD) patients, but their relationship has not been studied. This study evaluated and compared cognitive and motor performance during dual tasks and related dorsolateral prefrontal cortex (PFC) changes in oxygenated hemoglobin (ΔO2Hb), a proxy measure of neural activity, in patients with COPD and age-matched healthy individuals. Participants performed three single tasks: (1) backwards spelling cognitive task; (2) 30 m preferred paced walk; (3) 30 m fast walk, and two dual tasks: (4) preferred paced walk + backwards spelling; (5) fast paced walk + backwards spelling. The ΔO2Hb from left and right dorsolateral PFC were measured using functional near-infrared spectroscopy. Gait velocity was measured using a Zeno walkway. Compared to healthy adults (n = 20), patients with COPD (n = 15) had higher ΔO2Hb during single preferred (-0.344 ± 0.185 vs. 0.325 ± 0.208 µM; p = 0.011) and fast paced walk (-0.249 ± 0.120 vs. 0.486 ± 0.182 µM; p = 0.001) in right PFC. Among healthy adults, ΔO2Hb were higher bilaterally during preferred paced walking dual versus single task (right: 0.096 ± 0.159 vs. -0.344 ± 0.185 µM, p = 0.013; left: 0.114 ± 0.150 vs. -0.257 ± 0.175 µM, p = 0.049) and in right PFC during fast walking dual versus single task (0.102 ± 0.228 vs. -0.249 ± 0.120, p = 0.021). Patients with COPD did not increase O2Hb during dual versus single tasks. Patients with COPD exhibited slower velocity than older adults during all walking tasks. The lack of further increase in O2Hb from single to dual tasks in patients with COPD, may indicate reduced cognitive-motor capacity and contribute to poorer motor performance limiting safe ambulation. Dual tasking rehabilitation may improve neural efficiency to offset these risks.
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Affiliation(s)
- S Ahmed Hassan
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Leandro Viçosa Bonetti
- Post-Graduation Program in Health Sciences, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil.,Department of Physical Therapy, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Kara K Patterson
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,KITE - Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Deryk S Beal
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Guilherme A F Fregonezi
- PneumoCardioVascular Lab/HUOL, Hospital Universitário Onofre Lopes, Empresa Brasileira de Serviços Hospitalares and Laboratório de Inovação Tecnológica em Reabilitação, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Matthew B Stanbrook
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - W Darlene Reid
- Physical Therapy, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,KITE - Toronto Rehab-University Health Network, Toronto, Ontario, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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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.
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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
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15
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Presence or Absence of Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease is Associated With Distinct Phenotypes. Arch Bronconeumol 2020; 57:264-272. [PMID: 32115277 DOI: 10.1016/j.arbres.2019.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/19/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Reduced skeletal muscle function and cognitive performance are common extrapulmonary features in Chronic Obstructive Pulmonary Disease (COPD) but their connection remains unclear. Whether presence or absence of skeletal muscle dysfunction in COPD patients is linked to a specific phenotype consisting of reduced cognitive performance, comorbidities and nutritional and metabolic disturbances needs further investigation. METHODS Thirty-seven patients with COPD (grade II-IV) were divided into two phenotypic cohorts based on the presence (COPD dysfunctional, n=25) or absence (COPD functional, n=12) of muscle dysfunction. These cohorts were compared to 28 healthy, age matched controls. Muscle strength (dynamometry), cognitive performance (Trail Making Test and STROOP Test), body composition (Dual-energy X-Ray Absorptiometry), habitual physical activity, comorbidities and mood status (questionnaires) were measured. Pulse administration of stable amino acid tracers was performed to measure whole body production rates. RESULTS Presence of muscle dysfunction in COPD was independent of muscle mass or severity of airflow obstruction but associated with impaired STROOP Test performance (p=0.04), reduced resting O2 saturation (p=0.003) and physical inactivity (p=0.01), and specific amino acid metabolic disturbances (enhanced leucine (p=0.02) and arginine (p=0.06) production). In contrast, COPD patients with normal muscle function presented with anxiety, increased fat mass, plasma glucose concentration, and metabolic syndrome related comorbidities (hypertension and dyslipidemia). CONCLUSION COPD patients with muscle dysfunction show characteristics of a cognitive - metabolic impairment phenotype, influenced by the presence of hypoxia, whereas those with normal muscle function present a phenotype of metabolic syndrome and mood disturbances.
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16
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Patient Perceptions of the Adequacy of Supplemental Oxygen Therapy. Results of the American Thoracic Society Nursing Assembly Oxygen Working Group Survey. Ann Am Thorac Soc 2019; 15:24-32. [PMID: 29048941 DOI: 10.1513/annalsats.201703-209oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Pulmonary clinicians and patients anecdotally report barriers to home supplemental oxygen services including inadequate supply, unacceptable portable options, and equipment malfunction. Limited evidence exists to describe or quantify these problems. OBJECTIVES To describe the frequency and type of problems experienced by supplemental oxygen users in the United States. METHODS The Patient Supplemental Oxygen Survey, a self-report questionnaire, was posted on the American Thoracic Society Public Advisory Roundtable and patient and health care-affiliated websites. Respondents were invited to complete the questionnaire, using targeted e-mail notifications. Data were analyzed using descriptive statistics, paired t tests, and χ2 analysis. RESULTS In total, 1,926 responses were analyzed. Most respondents reported using oxygen 24 h/d, for 1-5 years, and 31% used high flow with exertion. Oxygen use varied, with only 29% adjusting flow rates based on oximeter readings. The majority (65%) reported not having their oxygen saturation checked when equipment was delivered. Sources of instruction included the delivery person (64%), clinician (8%), and no instruction (10%). Approximately one-third reported feeling "very" or "somewhat" unprepared to operate their equipment. Fifty-one percent of the patients reported oxygen problems, with the most frequent being equipment malfunction, lack of physically manageable portable systems, and lack of portable systems with high flow rates. Most respondents identified multiple problems (average, 3.6 ± 2.3; range, 1-12) in addition to limitations in activities outside the home because of inadequate portable oxygen systems (44%). Patients living in Competitive Bidding Program areas reported oxygen problems more often than those who did not (55% [389] vs. 45% [318]; P = 0.025). Differences in sample characteristics and oxygen problems were noted across diagnostic categories, with younger, dyspneic, high-flow users, and respondents who did not receive oxygen education, relating more oxygen problems. Respondents reporting oxygen problems also experienced increased health care resource utilization. CONCLUSIONS Supplemental oxygen users experience frequent and varied problems, particularly a lack of access to effective instruction and adequate portable systems. Initiatives by professional and patient organizations are needed to improve patient education, and to promote access to equipment and services tailored to each patient's needs.
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17
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Janssens JP, Weber C, Herrmann FR, Cantero C, Pessina A, Matis C, Merlet Viollet R, Boiche-Brouillard L, Stirnemann J, Pautex S. Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study. Respiration 2019; 97:406-415. [PMID: 30650418 DOI: 10.1159/000495312] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
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Affiliation(s)
- Jean-Paul Janssens
- Division of Pulmonary Diseases, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland,
| | - Catherine Weber
- Department of Community Medicine, Primary Care, and Emergency, Geneva University Hospitals, Geneva, Switzerland
| | - François R Herrmann
- Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Chloé Cantero
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Aline Pessina
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Caroline Matis
- Department of Palliative Care and Rehabilitation, Geneva University Hospitals, Geneva, Switzerland
| | - Roselyne Merlet Viollet
- Center for Clinical Research, Department of Anesthesiology, Pharmacology, and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | | | - Jerôme Stirnemann
- Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- Department of Community Medicine, Primary Care, and Emergency, Geneva University Hospitals, Geneva, Switzerland
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18
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Bayat A, Saki N, Nikakhlagh S, Mirmomeni G, Raji H, Soleimani H, Rahim F. Is COPD associated with alterations in hearing? A systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018; 14:149-162. [PMID: 30643401 PMCID: PMC6312399 DOI: 10.2147/copd.s182730] [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: 12/19/2022] Open
Abstract
Background and aims COPD is an irreversible or persistent airflow obstruction, which affects up to 600 million people globally. The primary purpose of this systematic review was to explore the COPD-based alteration in the auditory system function by conducting a quantitative analysis of presently published data. Materials and methods We systematically searched seven diverse electronic databases and manual searching of references to identify relevant studies. Data from the selected studies were rated by two investigators independently in a blinded fashion. Meta-analysis was done on pooled data using Cochrane’s Review Manager 5.3. Results Sixteen articles received suitable scores and were thus included for further processes. Hearing loss (HL) was defined as a change in pure tone audiometry (PTA) thresholds, auditory brainstem response (ABR), and auditory P300 parameters. ABR wave was significantly elongated in patients with COPD than in controls (standardized mean difference [SMD]=0.27, 95% CI: 0.05–0.48, P=0.02). PTA was significantly higher in patients with COPD when compared with controls (SMD=1.76, 95% CI: 0.43–3.08, P=0.0004). We found that patients with COPD had a significantly higher latency than controls (SMD=1.30, 95% CI: 0.79–1.80, P=0.0001). Conclusion COPD patients had considerably greater incidence of HL when compared with controls. Interestingly, although the mean PTA thresholds at every frequency for COPD patients were higher than those for controls, these values were still in the slight to mild HL ranges. Prolonged ABR wave latencies in the COPD patients suggest retro-cochlear involvement. Thus, COPD most frequently clusters with HL, but it is worth noting that alteration in hearing is not always recognized by medical experts as a frequent comorbidity associated with COPD.
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Affiliation(s)
- Arash Bayat
- Department of Audiology, Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nader Saki
- Department of Otorhinolaryngology, Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz Iran
| | - Soheila Nikakhlagh
- Department of Otorhinolaryngology, Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz Iran
| | - Golshan Mirmomeni
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hanieh Raji
- Department of Internal Medicine, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hossein Soleimani
- Department of Audiology, Hearing Research Center, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Department of Molecular Medicine, Health Research Institute, Thalassemia and Hemoglobinopathies Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
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19
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Effects of exercise training on cognition in chronic obstructive pulmonary disease: A systematic review. Respir Med 2018; 139:110-116. [DOI: 10.1016/j.rmed.2018.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/09/2018] [Accepted: 05/06/2018] [Indexed: 11/20/2022]
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20
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Marco CA, Mann D, Rasp J, Ballester M, Perkins O, Holbrook MB, Rako K. Effects of opioid medications on cognitive skills among Emergency Department patients. Am J Emerg Med 2018; 36:1009-1013. [DOI: 10.1016/j.ajem.2017.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 10/18/2022] Open
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21
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Arslan F, Tasdemir S, Durmaz A, Tosun F. The effect of nasal polyposis related nasal obstruction on cognitive functions. Cogn Neurodyn 2018; 12:385-390. [PMID: 30137875 DOI: 10.1007/s11571-018-9482-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 01/17/2018] [Accepted: 02/26/2018] [Indexed: 11/28/2022] Open
Abstract
Chronic rhinosinusitis with nasal polyposis is a chronic inflammatory disease of the respiratory mucosa of the nasal cavity and paranasal sinuses. The aim of this study was investigate the effect of nasal obstruction related to chronic rhinosinusitis with nasal polyposis on cognitive functions. Patients with chronic rhinosinusitis with nasal polyposis causing bilateral total or near total nasal obstruction were enrolled in the study. Symptoms of nasal congestion, loss of smell, postnasal drip, headaches, snoring, concentration difficulties and blunted affect were evaluated by Visual Analog Scale. Brief symptom inventory test, Stroop test, visual aural digit span, serial digit learning test and P300 test were used to evaluate cognitive functions. Three months after treatment, the tests done before surgery were repeated and the results were compared. A total of 30 patients were included in the study. On the Visual Analog Scale, all symptoms showed significant postoperative improvement in all patients (p < 0.001 for all symptoms). Preoperative nasal congestion accompanied with impaired concentration were detected in 27 patients (90%), and these symptoms recovered in all these patients after treatment (p = 0.035) (correlation coefficient 0.4). Only 22 patients completed the neuropsychological tests. The mean preoperative Stroop test (23.16 ± 5.30), visual aural digit span test (24.68 ± 3.52), and serial digit learning test (16.18 ± 5.35) scores were showed significant improvement compared with mean postoperative Stroop test (21.12 ± 5.69), visual aural digit span test (26.45 ± 2.98), and serial digit learning test (19.31 ± 4.47) scores (p = 0.047, p = 0.022, p = 0.005 respectively). The postoperative P300 latency values improved in 19 (63%) patients. The preoperative and postoperative latency values for P300 showed a significant difference (p = 0.029), whereas the preoperative and postoperative amplitude values for P300 did not differ (p = 0.096). In conclusion, the results of this study indicate that chronic rhinosinusitis with nasal polyposis (CRSwNP) has negative effects on cognitive functions, such as the ability to focus and maintain concentration. These cognitive functions improve after the patients undergo endoscopic sinus surgery to treat their CRSwNP.
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Affiliation(s)
- Fatih Arslan
- Department of Otolaryngology, Head and Neck Surgery, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Serdar Tasdemir
- Department of Neurology, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - Abdullah Durmaz
- 3Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
| | - Fuat Tosun
- 3Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey
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22
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Wen XH, Li Y, Han D, Sun L, Ren PX, Ren D. The relationship between cognitive function and arterial partial pressure O2 in patients with COPD: A meta-analysis. Medicine (Baltimore) 2018; 97:e9599. [PMID: 29369175 PMCID: PMC5794359 DOI: 10.1097/md.0000000000009599] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The high incidence of cognition disorders in chronic obstructive pulmonary disease (COPD) patients represents a main focus in public health field recently. Thus, we tried to explore relationship between cognitive function and arterial partial pressure O2 (PaO2) in patients with COPD as assessed by Mini-mental State Examination (MMSE) and/or Montreal Cognitive Assessment (MoCA). MATERIALS AND METHODS Medical and scientific literature databases, such as Web of Science, PubMed, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database, were searched independently by 2 reviewers until February 2016. Correlation coefficient (r or rs) values were obtained from each study, and 95% confidence intervals (CIs) were calculated using STATA12.0 software. RESULTS A total of 2049 studies were produced, and 9 of which were analyzed (714 participants) in the meta-analysis. The pooled r observed medium relationship for all selected studies (r = 0.405, 95% CI 0.31-0.55), and notable heterogeneity was also tested between studies (χ = 17.72, P = .023; I = 54.9%). After the sensitivity and subgroup analysis, the heterogeneity significantly decreased. Subgroup analysis showed that MMSE score was stronger correlation between PaO2 and cognitive function than MoCA score in the COPD patients. Begg test did not indicate potential risk of publication bias. CONCLUSIONS There was a negative correlation between cognitive function and anoxia in patients with COPD, so it may be extremely essential to predict and improve the status of hypoxia in COPD patients.
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Affiliation(s)
- Xia-Hong Wen
- The Second Department of Respiratory, Shaanxi Provincial People's Hospital
| | - Yan Li
- The Second Department of Respiratory, Shaanxi Provincial People's Hospital
| | - Dong Han
- The Second Department of Respiratory, Shaanxi Provincial People's Hospital
| | - Li Sun
- The Second Department of Respiratory, Shaanxi Provincial People's Hospital
| | - Ping-Xiao Ren
- The Second Department of Respiratory, Shaanxi Provincial People's Hospital
| | - Dan Ren
- Xi’an Medical University, Xi’an, Shaanxi, China
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Yohannes AM, Chen W, Moga AM, Leroi I, Connolly MJ. Cognitive Impairment in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: A Systematic Review and Meta-analysis of Observational Studies. J Am Med Dir Assoc 2017; 18:451.e1-451.e11. [DOI: 10.1016/j.jamda.2017.01.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/18/2022]
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Andrianopoulos V, Gloeckl R, Vogiatzis I, Kenn K. Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment? Breathe (Sheff) 2017; 13:e1-e9. [PMID: 29184593 PMCID: PMC5702891 DOI: 10.1183/20734735.001417] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 11/09/2022] Open
Abstract
Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment. EDUCATIONAL AIMS To illustrate the common signs of cognitive impairment and define potential associations between lung and cognitive dysfunction.To illustrate the potential influence of cognitive deficits on the optimal progress of respiratory therapy.To illustrate the importance of cognitive evaluation as part of a comprehensive clinical assessment for patients suspected of suffering cognitive impairment.
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Affiliation(s)
- Vasileios Andrianopoulos
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
| | - Rainer Gloeckl
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ioannis Vogiatzis
- Dept of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Dept of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Klaus Kenn
- Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
- Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
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25
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Antoniu SA, Boiculese LV. Palliative care outcome measures in COPD patients: a conceptual review. Expert Rev Pharmacoecon Outcomes Res 2016; 16:267-74. [PMID: 26967768 DOI: 10.1586/14737167.2016.1162714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In chronic obstructive pulmonary disease (COPD), palliative care is appropriate in very advanced stages based on recognition of its need when conventional therapy is no longer able to control symptoms, disease morbidity, or to improve/maintain an acceptable quality of life. Palliative care aims to improve quality of life, or, if applied specifically at the end-of-life, to ensure comfortable care. In COPD palliative care effectiveness of interventions should be quantified with outcome measures able to better capture the holistic nature of approaches and not only the specific features of disease. These should include: physical outcomes, psychological outcomes, social outcomes, spiritual outcomes. Such measures are discussed in this review along with arguments supporting their use.
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Affiliation(s)
- Sabina Antonela Antoniu
- a Department of Preventive Medicine Interdisciplinarity, Medicine-Palliative Care Nursing , University of Medicine and Pharmacy, 'Gr.T.Popa' Iasi , Iasi , Romania
| | - Lucian Vasile Boiculese
- a Department of Preventive Medicine Interdisciplinarity, Medicine-Palliative Care Nursing , University of Medicine and Pharmacy, 'Gr.T.Popa' Iasi , Iasi , Romania
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