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Li J, Sun J, Zhang Y, Zhang B, Zhou L. Association between weight-adjusted-waist index and cognitive decline in US elderly participants. Front Nutr 2024; 11:1390282. [PMID: 38903624 PMCID: PMC11187255 DOI: 10.3389/fnut.2024.1390282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/16/2024] [Indexed: 06/22/2024] Open
Abstract
Objective To investigate the association between the weight-adjusted-waist index (WWI) and cognitive decline in elderly Americans from 2011 to 2014. Methods A cross-sectional study was conducted on 2,762 elderly participants from the National Health and Nutrition Examination (NHANES) between 2011 and 2014. WWI was calculated by dividing waist circumference (cm) by the square root of body weight (kg). Participants assessed their cognitive functions using tests such as the DSST, AFT, and CERAD W-L. In this research, multiple logistic regression, HIA, limited cubic spline (RCS), and threshold effect analysis methods were utilized to explore the relationship between cognitive decline and WWI. Results The study involved 2,762 participants aged 60 years and older, comprising 1,353 males (49%) and 1,409 females (51%), with a median age of 69.3 years (standard deviation = 6.7). The analysis revealed that the risk of cognitive decline was positively associated with the WWI. Fully adjusted models indicated significant correlations with the CERAD W-L [odds ratio (OR) = 1.24, 95% confidence interval (CI) = 1.06-1.46, p < 0.008], AFT (OR = 1.27, 95% CI = 1.08-1.49, p = 0.003), and DSST (OR = 1.56, 95% CI = 1.29-1.9, p < 0.001). Subgroup analysis demonstrated a consistent relationship across different population settings except for gender (average of interactions, p > 0.05). A J-shaped relationship between WWI and low DSST scores was observed using multivariate restricted cubic spline (RCS) regression (P for non-linearity <0.05), with the curve steepening when WWI ≥ 12.21 cm/√kg. Additionally, the study found that WWI was more strongly associated with an increased risk of cognitive decline than other obesity indicators such as Body Mass Index (BMI), waist circumference (WC), and A Body Shape Index (ABSI). Conclusion Our data have shown a significant positive association between the WWI and a higher risk of cognitive decline in older Americans, with a J-shaped non-linear relationship between WWI and DSST. In addition, our findings indicate that WWI was associated with greater cognitive decline than other markers of obesity.
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Affiliation(s)
| | | | | | | | - Liya Zhou
- Changchun University of Chinese Medicine, Changchun, China
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Dag B, Naz İ, Felekoglu E, Emuk Y, Kopruluoglu M, Sahin H. Associations of Upper-Extremity Exercise Capacity and Grip Strength With Cognitive Domains in Patients With COPD. Respir Care 2024; 69:595-602. [PMID: 38378201 PMCID: PMC11147619 DOI: 10.4187/respcare.11610] [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: 02/22/2024]
Abstract
BACKGROUND Cognitive impairment (CI), which has been reported in COPD, has been related to physical performance. However, the association between CI and upper-extremity functions is unknown. We aimed to compare upper-extremity exercise capacity and grip strength between subjects with COPD with and without CI and to determine the relationship of upper-extremity functions with specific cognitive domains. METHODS In this cross-sectional study, 76 subjects with COPD (mean age 66.8 ± 7.5 y, FEV1% 47.12 ± 14.10) were classified as with and without CI according to the Montreal Cognitive Assessment. Clinical characteristics, upper-extremity exercise capacity (6-min pegboard ring test [6PBRT]), grip strength (hand dynamometer), dyspnea severity (modified Medical Research Council dyspnea scale), disease-specific health status (COPD Assessment Test), and disease-specific quality of life (St George Respiratory Questionnaire) were compared between groups, and the relationship of upper-extremity functions with cognitive subdomains was analyzed by multivariate regression analysis. RESULTS The number of 6PBRT rings (P = .01) and the grip strength (P = .033) were lower in subjects with CI. Subjects with CI had lower FEV1% (P = .038), arterial oxygenation (P = .002), exercise habits (P = .033), health status (P = .01), quality of life (P = .042); and higher dyspnea (P < .001), smoking consumption (P = .032), emergency admission (P = .02), and hospitalization (P = .042). The adjusted model showed that executive functions and attention were related to upper-extremity capacity (β = 14.4 and β = 10.2, respectively) and hand-grip strength (β = 1.85 and β = 1.49, respectively). CONCLUSIONS These findings suggest that upper-extremity functions might be decreased especially concerning executive functions and attention in subjects with COPD with CI.
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Affiliation(s)
- Bedriye Dag
- Izmir Kâtip Celebi University, Institute of Health Sciences, Izmir, Turkey
| | - İlknur Naz
- Izmir Kâtip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey.
| | - Elvan Felekoglu
- Izmir Kâtip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Yusuf Emuk
- Izmir Kâtip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Melissa Kopruluoglu
- Izmir Kâtip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey
| | - Hulya Sahin
- Health Science University, Dr Suat Seren Chest Disease and Surgery Training and Research Hospital, Izmir, Turkey
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3
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Liu M, Wang D, Fang J, Chang Y, Hu Y, Huang K. Validation of the Generalized Anxiety Disorder-7 in patients with COPD: a cross-sectional study. BMC Psychiatry 2023; 23:593. [PMID: 37582707 PMCID: PMC10428582 DOI: 10.1186/s12888-023-05072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often have comorbid generalized anxiety disorder (GAD), which requires early screening in respiratory clinics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire is a brief and commonly used screening tool for GAD but has not been validated among patients with COPD in China. METHODS Stable patients with COPD from a cross-sectional observational study were assessed using the GAD-7 questionnaire and then assessed by a senior psychiatrist to confirm a diagnosis of GAD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Demographic characteristics, spirometry, and patient-reported outcomes were collected. Cronbach's α coefficient was calculated, and receiver operating curve (ROC) analysis was performed to validate the GAD-7. RESULTS A total of 226 patients with COPD were enrolled, and 50 (22.1%) of these patients were diagnosed with GAD. The Cronbach's α coefficient for the GAD-7 was 0.869, which indicated good internal consistency. ROC curve analysis showed that the GAD-7 had an area under the curve (AUC) value of 0.829 (95% CI: 0.774-0.876) for identifying GAD. The optimal cut-off score was ≥ 4, with a sensitivity of 66.0% and a specificity of 89.2%. Higher GAD-7 scores were significantly associated with health-related quality of life and the symptom burden of COPD. The discriminatory power of GAD-7 did not differ statistically when stratified by COPD severity. CONCLUSIONS The GAD-7 was shown to be a reliable and valid screening tool for patients with COPD in China, and its screening performance for GAD was not influenced by disease severity.
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Affiliation(s)
- Meishan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Dong Wang
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Jiexin Fang
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Yuhan Chang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China
| | - Yongdong Hu
- Department of Clinical Psychology, Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China.
| | - Kewu Huang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No 8, Gongti South Road, 100020, Chaoyang District, Beijing, PR China.
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4
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Tsai CL, Chang WP, Lin YK, Ho SC, Lin YH. Physical frailty related to cognitive impairment and COPD exacerbation: A cross-sectional study. Respir Med 2023; 208:107129. [PMID: 36709919 DOI: 10.1016/j.rmed.2023.107129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/14/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Chen-Liang Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Wen Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan.
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei City, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Yu-Huei Lin
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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Fumagalli A, Misuraca C, Riva S, Soraci L, Fabbietti P, Di Rosa M, Corsonello A, Lattanzio F, Colombo D. Does trail making test predict long-term prognosis in older patients with COPD? Aging Clin Exp Res 2021; 33:1699-1703. [PMID: 32803695 DOI: 10.1007/s40520-020-01680-3] [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: 05/16/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
Executive abilities are frequently impaired in patients with chronic obstructive pulmonary disease (COPD). We aimed at investigating the association between trail making test (TMT) and survival. Our series consisted of 68 stable COPD outpatients followed-up every 6 months for 52.6 ± 27.6 months. Enrolled patients underwent a baseline comprehensive neuropsychological assessment, including mini-mental state exam, attentional matrices, digit span, Rey auditory verbal learning, Rey-Osterrieth complex figure, copy drawing, tokens test, verbal fluency, category fluency, frontal assessment battery, Raven's progressive matrices, TMT-A, -B and -B-A. The association between neuropsychological deficits and overall mortality was investigated by Cox regression. During follow-up period, 41 patients (60.3%) died. After adjusting for potential confounders, TMT-B was significantly associated with mortality (HR = 2.42, 95% CI = 1.10-5.31), along with age (HR = 1.06, 95% CI = 1.0-1.13), overall comorbidity (HR = 1.29, 95% CI = 1.02-1.62) and use of noninvasive ventilation (HR = 2.16, 95% CI = 1.05-4.45). Defective TMT-B may be associated with long-term mortality in patients with stable COPD.
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Benefits of pulmonary rehabilitation in COPD patients with mild cognitive impairment - A pilot study. Respir Med 2021; 185:106478. [PMID: 34038843 DOI: 10.1016/j.rmed.2021.106478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cognitive impairment might interfere with the efficacy of Pulmonary Rehabilitation (PR) in Chronic Obstructive Pulmonary Disease (COPD). We aimed to identify differential responses to PR between cognitively impaired (CI) and cognitively normal (CN) COPD patients by assessing health status and exercise capacity. METHODS Sixty patients (FEV1: 47 ± 15%) were classified as CI or CN according to the Montreal Cognitive Assessment (MoCA ≤25points) and completed a 3-week inpatient PR program. Cognitive function (neuropsychological battery), health-status (36-Item Short Form Survey [SF-36]), and exercise capacity (6-min walk test [6MWT], cycle-endurance test [CET]) were assessed before and after PR. Responsiveness to PR was estimated by mean change (delta-value [Δ]) and the d-Effect Size (ES). RESULTS Twenty-five COPD patients (42%) presented evidence of mild CI prior to PR. Both, CI and CN patients significantly improved global cognitive function, health status (the majority of SF-36 components), and exercise capacity (6MWT and cycle endurance) in response to PR. Compared to CN, CI patients did not improve SF-36 subdomains of "role emotional" and "bodily pain", and demonstrated a lower magnitude of improvement in 6MWT ([Δ]: 25 m; ES: 0.21) compared to CN ([Δ]: 46 m; ES: 0.54). CONCLUSIONS PR has favorable effects on global cognitive function, health status, and exercise capacity in both CI and CN COPD patients. There was no concrete evidence to indicate interference of cognitive impairment to PR effectiveness.
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Siraj RA, McKeever TM, Gibson JE, Gordon AL, Bolton CE. Risk of incident dementia and cognitive impairment in patients with chronic obstructive pulmonary disease (COPD): A large UK population-based study. Respir Med 2021; 177:106288. [PMID: 33401149 DOI: 10.1016/j.rmed.2020.106288] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/04/2020] [Accepted: 12/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although cognitive impairment and dementia are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), estimates of incidence following a diagnosis of COPD are inconclusive. OBJECTIVE To determine the incidence of cognitive impairment and dementia in people with and without a COPD diagnosis. METHODS A population-based study using UK General Practice (GP) health records from The Health Improvement Network database was conducted. Patients with confirmed COPD diagnosis, ≥40 years old, were matched to up to four subjects without a COPD diagnosis by age, sex and GP practice. Cox proportional hazards models were used to assess the incidence rates of cognitive impairment and dementia. RESULTS Of patients with COPD (n = 62,148), 9% developed cognitive impairment, compared with 7% of subjects without COPD (n = 230,076), p < 0.001. The incidence of cognitive impairment following COPD diagnosis was greater than in subjects without COPD following index date (adjusted Hazard Ratio (aHR), 1.21; 95% CI: 1.16 ─ 1.26, p < 0.001). The coded incidence of either cognitive impairment or dementia was also greater in patients with COPD following adjustment for confounders (aHR: 1.13, 95% CI: 1.09 ─ 1.18, p < 0.001). Coded incident dementia alone was not different between patients with COPD and subjects without COPD (aHR, 0.91, 95% CI: 0.83 ─ 1.01, p = 0.053). CONCLUSION Despite the increased incidence of cognitive impairment in patients with COPD, incidence of dementia was not as frequently recorded in patients with COPD. This raises the concern of undiagnosed dementia and emphasises the need for a systematic assessment in this population.
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Affiliation(s)
- R A Siraj
- NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - T M McKeever
- NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - J E Gibson
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - A L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Derby, UK; NIHR Nottingham Biomedical Research Centre, Musculoskeletal Theme, School of Medicine, University of Nottingham, Nottingham, UK
| | - C E Bolton
- NIHR Nottingham Biomedical Research Centre Respiratory Medicine, School of Medicine, University of Nottingham, City Hospital NUH Trust site, Nottingham, UK.
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8
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Riordan P, Stika M, Goldberg J, Drzewiecki M. COVID-19 and clinical neuropsychology: A review of neuropsychological literature on acute and chronic pulmonary disease. Clin Neuropsychol 2020; 34:1480-1497. [PMID: 32883155 DOI: 10.1080/13854046.2020.1810325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The illness resulting from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), better known as COVID-19, has quickly escalated to a worldwide pandemic. Although understanding of the short and long-term manifestations of COVID-19 remains incomplete, there is a preponderance of respiratory pathology in COVID-19 and potential for chronic loss of pulmonary function in recovered patients, raising concerns for associated cognitive impacts.Method: We conducted a narrative review of the existing literature on neuropsychological variables in acute/severe respiratory disease and various forms of chronic pulmonary disease to inform expectations about potential cognitive manifestations of COVID-19.Results: Cognitive dysfunction is common but not inevitable in acute and chronic pulmonary disease, although unique predictors and symptom trajectories appear to be associated with each.Conclusions: Although the full scope of neuropathophysiology associated with COVID-19 remains to be established, pulmonary insults associated with the disease are likely to produce cognitive dysfunction in a substantial percentage of patients.
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Affiliation(s)
- Patrick Riordan
- Mental Health Service, Hines VA Medical Center, Hines, IL, USA.,Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Monica Stika
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| | - Joshua Goldberg
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
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Affiliation(s)
- Daniel H Higbee
- Academic Respiratory Unit, University of Bristol, Southmead Hospital , Bristol, UK
| | - James W Dodd
- Academic Respiratory Unit, University of Bristol, Southmead Hospital , Bristol, UK
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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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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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12
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Omori H, Higashi N, Nawa T, Fukui T, Kaise T, Suzuki T. Chronic Cough and Phlegm in Subjects Undergoing Comprehensive Health Examination in Japan - Survey of Chronic Obstructive Pulmonary Disease Patients Epidemiology in Japan (SCOPE-J). Int J Chron Obstruct Pulmon Dis 2020; 15:765-773. [PMID: 32346287 PMCID: PMC7167268 DOI: 10.2147/copd.s237568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to estimate the prevalence of subjects with chronic cough and phlegm and describe their characteristics including the presence or absence of airflow limitation among the general population in Japan. Subjects and Methods This was an observational cross-sectional survey targeting multiple regions of Japan. Subjects aged 40 years or above who were undergoing comprehensive health examination were recruited. The existence of chronic cough and phlegm, airflow limitation, and treatment for respiratory diseases were examined. Chronic cough and phlegm were defined as having both symptoms for at least 3 months of the year and for at least 2 consecutive years, or as receiving any treatment for chronic bronchitis at the time of recruitment. Airflow limitation was defined as forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) less than 0.7. Results In a total of 22,293 subjects, 380 subjects (1.7%) had chronic cough and phlegm. Among these 380 subjects, 21.8% received treatment for a respiratory disease, and 11.6% had airflow limitation. Compared to subjects without both chronic cough and phlegm but with airflow limitation, subjects with chronic cough and phlegm without airflow limitation were younger, more likely to be current smokers (39.6%), and had higher total scores on a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Scores of CAT questions 1-4 (cough, phlegm, chest tightness, breathlessness, respectively) were higher in subjects with chronic cough and phlegm regardless of airflow limitation. Conclusion This study demonstrated that subjects identified to have chronic cough and phlegm in comprehensive health examination settings were symptomatic, while most of them did not receive any treatment for respiratory diseases and did not have airflow limitation. Screening subjects for chronic cough and phlegm in a comprehensive health examination followed by a detailed examination of screened subjects could be an effective approach for better management of chronic cough and phlegm. Smoking cessation should be included in the management, in consideration that around 40% of subjects with chronic cough and phlegm were current smokers.
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Affiliation(s)
- Hisamitsu Omori
- Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Takeshi Nawa
- Department of Internal Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Toshiki Fukui
- Center for Preventive Medical Treatment, Olive Takamatsu Medical Clinic, Takamatsu, Japan
| | - Toshihiko Kaise
- Japan Development Division, GlaxoSmithKline K.K., Tokyo, Japan
| | - Takeo Suzuki
- Japan Development Division, GlaxoSmithKline K.K., Tokyo, Japan
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13
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Sung CE, Huang RY, Cheng WC, Kao TW, Chen WL. Association between periodontitis and cognitive impairment: Analysis of national health and nutrition examination survey (NHANES) III. J Clin Periodontol 2019; 46:790-798. [PMID: 31152592 DOI: 10.1111/jcpe.13155] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/21/2019] [Accepted: 05/26/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Periodontitis has been hypothesized as being one of the most common potential risk factors for the development of dementia and cognitive impairment. In order to investigate the relationship between periodontitis and cognition impairment, the National Health and Nutrition Examination Survey (NHANES) database was analysed after adjusting for potential confounding factors, including age and other systemic co-morbidities. MATERIALS AND METHODS In total, 4,663 participants aged 20-59 years who had received full-mouth periodontal examination and undergone the cognitive functional test were enrolled. The grade of periodontal disease was categorized into severe, moderate, and mild. Cognitive function examinations, including the simple reaction time test (SRTT), symbol digit substitution test (SDST), and serial digit learning test (SDLT), were adopted for the evaluation of cognitive impairment. RESULTS The subjects with mild and moderate to severe periodontitis had higher SDLT and SDST scores, which indicated decreased cognitive function, compared with the healthy group. After adjusting for demographic factors, education, smoking, cardiovascular diseases, and laboratory data, periodontitis was significantly correlated with elevated SDST and SDLT scores (p values for trend = 0.014 and 0.038, respectively) by generalized linear regression models. CONCLUSION Our study highlighted that periodontal status was associated with cognitive impairment in a nationally representative sample of US adults.
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Affiliation(s)
- Cheng-En Sung
- Department of Periodontology, School of Dentistry, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Wan-Chien Cheng
- Department of Periodontology, School of Dentistry, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China.,School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China.,School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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14
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Morris C, Mitchell JW, Moorey H, Younan HC, Tadros G, Turner AM. Memory, attention and fluency deficits in COPD may be a specific form of cognitive impairment. ERJ Open Res 2019; 5:00229-2018. [PMID: 31149625 PMCID: PMC6536863 DOI: 10.1183/23120541.00229-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/01/2019] [Indexed: 11/09/2022] Open
Abstract
There is increasing evidence demonstrating an association between chronic obstructive pulmonary disease (COPD) and cognitive impairment. We present a narrative review of published studies on the subject and a cross-sectional study investigating domain-specific cognitive impairment in people with COPD compared to people with known Alzheimer's dementia, and controls without known COPD or cognitive impairment. The aim of the study was to compare prevalence and pattern of cognitive impairment between the three groups using the Addenbrooke's Cognitive Examination (ACE)-III tool. A total of 89 participants were recruited (44 with COPD, 17 with Alzheimer's and 28 controls). Patients with COPD had significantly lower total ACE-III scores than controls (p<0.001). When comparing the COPD group to the known Alzheimer's dementia group, overall ACE-III scores were significantly lower in the Alzheimer's dementia group than the COPD group (p=0.019). The domain-specific scores for attention (p<0.004), memory (p<0.004) and fluency (p<0.001) were significantly lower in the Alzheimer's dementia group than the COPD group. Our result suggest that the COPD group were significantly more likely to have cognitive impairment than the healthy control group. This was supported by the results of a narrative review of the published literature. Our results show that the pattern of impairment in the COPD group is different to the pattern of impairment shown in the known Alzheimer's dementia group, with significant differences in the cognitive domains affected. These results are in keeping with the findings of other previously published studies included in the narrative review. People with COPD are more likely than controls to have cognitive impairment. When compared to people with known Alzheimer's disease, the pattern of impairment and cognitive domains affected are significantly different.http://bit.ly/2VPFxjh
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Affiliation(s)
- Charlotte Morris
- University Hospitals Birmingham Foundation Trust, Birmingham, UK.,These authors contributed equally
| | - James W Mitchell
- University Hospitals Birmingham Foundation Trust, Birmingham, UK.,These authors contributed equally
| | - Hannah Moorey
- University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | | | - George Tadros
- Aston Medical School, Birmingham, UK.,Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Alice M Turner
- University Hospitals Birmingham Foundation Trust, Birmingham, UK.,University of Birmingham, Birmingham, UK
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15
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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
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16
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Vespasiani-Gentilucci U, Pedone C, Muley-Vilamu M, Antonelli-Incalzi R. The pharmacological treatment of chronic comorbidities in COPD: mind the gap! Pulm Pharmacol Ther 2018; 51:48-58. [PMID: 29966745 DOI: 10.1016/j.pupt.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is commonly associated with other chronic diseases, which poses several diagnostic and therapeutic problems. Indeed, important comorbidities frequently remain unrecognized and, then, untreated, whereas respiratory drugs may have non respiratory side effects, and selected non respiratory drugs may variably affect the respiratory function. OBJECTIVE to describe: how COPD affects the presentation and contributes to the diagnostic challenges of its most common comorbidities; how coexisting COPD impacts the therapeutic approach to selected comorbidities and viceversa. METHODS we distinguish comorbidities of COPD depending upon whether they are complications of COPD or share risk factors, mainly smoke, with it or, finally, aggravate COPD. We describe atypical presentations of and diagnostic clues to comorbidities and suggest screening procedures. Finally, the main therapeutic problems, as resulting from the risk of untoward effects of therapies of COPD and its comorbidity, with special attention to drug-drug interactions and possible overdosages, are described. RESULTS selected complications of COPD, such as osteoporosis, sarcopenia and dysphagia, are rarely recognized and treated, likely due to the poor awareness of them. Important comorbidities, such as coronary artery disease, chronic heart failure, obstructive sleep apnoea syndrome and chronic renal failure, also should be systematically searched for because of their commonly variant presentation. Disease-related symptoms should be distinguished from drug effects or drug-drug interaction effects. CONCLUSIONS a truly comprehensive view of the complex COPD patient, hopefully capitalizing on multidimensional geriatric assessment, is needed to dissect the many components of health status impairment and to provide the optimal care. Selected screening procedures are highly desirable to identify frequently missed comorbidities. Pharmacosurveillance is an essential part of the approach to COPD and its comorbidities.
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Affiliation(s)
| | - Claudio Pedone
- Internal Medicine and Geriatrics Area, University Campus Bio-Medico of Rome, Italy
| | - Moises Muley-Vilamu
- Internal Medicine and Geriatrics Area, University Campus Bio-Medico of Rome, Italy
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17
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Patel M, Steinberg K, Suarez-Barcelo M, Saffel D, Foley R, Worz C. Chronic Obstructive Pulmonary Disease in Post-acute/Long-term Care Settings: Seizing Opportunities to Individualize Treatment and Device Selection. J Am Med Dir Assoc 2018; 18:553.e17-553.e22. [PMID: 28549708 DOI: 10.1016/j.jamda.2017.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/28/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The burden of chronic obstructive pulmonary disease (COPD) in post-acute/long-term care (PA/LTC) settings is high, and many patients do not receive guideline-recommended care. METHODS An interprofessional expert panel of PA/LTC professionals convened to discuss the unmet medical needs in patients with COPD in PA/LTC settings, and to make recommendations for the assessment of COPD patients to individualize the selection of maintenance treatment. RESULTS Unmet needs observed in patients with COPD are described in addition to new tools for assessing individual patient abilities and appropriate device selection for maintenance treatment. CONCLUSION COPD management in PA/LTC settings needs to be reevaluated and updated to help reduce exacerbations, hospitalizations, and readmissions.
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Affiliation(s)
- Meenakshi Patel
- Wright State University, Boonshoft School of Medicine, Dayton, OH
| | - Karl Steinberg
- California State University Institute for Palliative Care, San Marcos, CA.
| | | | - Dana Saffel
- PharmaCare Strategies, Inc., Santa Rosa Beach, FL
| | | | - Chad Worz
- University of Cincinnati, College of Pharmacy, Cincinnati, OH
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18
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Zhu L, Ni Z, Luo X, Zhang Z, Wang S, Meng Z, Gu X, Wang X. The outcome and the influencing factors of the age of onset in post-mortem of chronic bronchitis patients: a retrospective study. Int J Chron Obstruct Pulmon Dis 2018; 13:645-652. [PMID: 29503538 PMCID: PMC5825962 DOI: 10.2147/copd.s157084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose Chronic bronchitis is thought to occur in elderly patients, and smoking seems to be an important risk factor. The outcomes related to the age of onset in patients with chronic bronchitis are still unclear. Patients and methods A retrospective study was conducted on deceased patients whose diagnosis included bronchitis from 2010 to 2016. Patients were separated into two groups according to the age of onset (Group I, age ≤50 years old; Group II, age >50 years old). Information regarding disease course, smoking history, death age, number of admissions per year, Hugh Jones Index, and self-reported comorbidities of the patients was recorded. Results The courses of chronic cough and sputum were 33.38±7.73 years and 14.44±8.60 years in Group I and Group II, respectively (p<0.05). The death ages of Group I and Group II were 77.65±7.87 years and 84.69±6.67 years, respectively (p<0.05). There was a significant negative correlation between the number of hospital admissions per year and the age of onset. The age of onset was negatively associated with daily smoking count (r=−0.210) and total smoking count (r=−0.146). In Group I, there were fewer cases of coronary heart disease (OR =0.41 [0.24–0.71]), neurological diseases (OR =0.48 [0.24–0.97]), and total comorbidities (OR =0.67 [0.54–0.85]) than in Group II. Conclusion Patients with early onset chronic bronchitis had a longer history, younger death age, poorer health status, and lower incidence of comorbidities.
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Affiliation(s)
- Linyun Zhu
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Zhenhua Ni
- Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuming Luo
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Zhuhua Zhang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Shiqiang Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Ziyu Meng
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Xiandong Gu
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Xiongbiao Wang
- Department of Respiratory Medicine, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai
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19
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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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20
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Yazar EE, Aydin S, Gunluoglu G, Kamat S, Gungen AC, Yildiz P. Clinical effects of cognitive impairment in patients with chronic obstructive pulmonary disease. Chron Respir Dis 2017; 15:306-314. [PMID: 29169250 PMCID: PMC6100172 DOI: 10.1177/1479972317743757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to evaluate the clinical effects of cognitive impairment in patients with chronic obstructive pulmonary disease (COPD). A total of 91 patients with stable moderate to very severe COPD were included in this study. Cognitive functions of the patients were evaluated using the mini-mental state examination (MMSE) tool and clock-drawing test. The Brody’s Instrumental Activities of Daily Living (IADL) Questionnaire; COPD assessment test (CAT); body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE); and Charlson comorbidity index were assessed. The patients were divided into two groups as those who were diagnosed with cognitive impairment (group 1, n = 16) and those with normal cognitive functions (group 2, n = 75). Group 1 had a lower arterial partial pressure of oxygen , shorter 6-min walking distance, and higher arterial partial pressure of carbon dioxide (PaCO2) than group 2 (p = 0.01, p = 0.024, p = 0.018, respectively). In group 1, the IADL score was lower, and CAT and BODE scores were higher than group 2 (p = 0.002, p = 0.037, p = 0.012, respectively). When we considered all the patients, there was an independent correlation between the IADL score and MMSE score (p = 0.03). This study revealed that COPD patients with cognitive impairment may have more hypoxemia and limited activities of daily living.
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Affiliation(s)
- Esra Ertan Yazar
- 1 Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training Hospital, University of Health Sciences, İstanbul, Turkey
| | - Senay Aydin
- 2 Department of Neurology, Yedikule Chest Disease and Thoracic Surgery Training Hospital, University of Health Sciences, İstanbul, Turkey
| | - Gulsah Gunluoglu
- 1 Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training Hospital, University of Health Sciences, İstanbul, Turkey
| | - Sadettin Kamat
- 3 Department of Pulmonology, Sinop Atatürk Government Hospital, Sinop, Turkey
| | - Adil Can Gungen
- 4 Department of Pulmonology, Research and Training Hospital, Sakarya University, Sakarya, Turkey
| | - Pinar Yildiz
- 1 Department of Pulmonology, Yedikule Chest Disease and Thoracic Surgery Training Hospital, University of Health Sciences, İstanbul, Turkey
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21
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Long-term safety of glycopyrrolate/eFlow® CS in moderate-to-very-severe COPD: Results from the Glycopyrrolate for Obstructive Lung Disease via Electronic Nebulizer (GOLDEN) 5 randomized study. Respir Med 2017; 132:251-260. [DOI: 10.1016/j.rmed.2017.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/30/2017] [Accepted: 08/20/2017] [Indexed: 12/19/2022]
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22
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Abdel Aziz AO, Abdel El Bary IM, Abdel Fattah MT, Magdy MA, Osman AM. Effectiveness and safety of noninvasive positive-pressure ventilation in hypercapnia respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/1687-8426.211398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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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.
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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
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Carlin BW, Schuldheisz SK, Noth I, Criner GJ. Individualizing the selection of long-acting bronchodilator therapy for patients with COPD: considerations in primary care. Postgrad Med 2017; 129:725-733. [PMID: 28707495 DOI: 10.1080/00325481.2017.1353885] [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: 12/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common condition encountered in primary care settings. COPD remains the third leading cause of death in the United States and carries a significant burden to both patients and the healthcare system. COPD is a chronic, progressive, irreversible lung disease associated with high morbidity and mortality. Proper assessment and diagnosis requires spirometry which is currently underutilized in primary care. Management is focused on adequate symptom control, improving quality of breathing and quality of life, and preventing exacerbations and hospitalizations. However, many patients are not receiving long-acting bronchodilator maintenance therapy as recommended in current clinical guidelines. Even when patients receive appropriate therapy, real-world issues such as a patient's health literacy, physical and cognitive limitations, and therapy nonadherence limit the effectiveness of prescribed inhaled medications. Primary care providers are well situated to ensure that prescribed therapies and long-term management goals are matched to the individual needs of patients with COPD.
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Affiliation(s)
- Brian W Carlin
- a Sleep Medicine and Lung Health Consultants , LLC , Pittsburgh , PA , USA
| | | | - Imre Noth
- c Interstitial Lung Disease Program , The University of Chicago Medicine , Chicago , IL , USA
| | - Gerard J Criner
- d Thoracic Medicine and Surgery, Lewis Katz School of Medicine , Temple University , Philadelphia , PA , USA
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25
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The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: A systematic review. Respir Med 2017; 129:130-139. [PMID: 28732820 DOI: 10.1016/j.rmed.2017.06.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/10/2017] [Accepted: 06/12/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the characteristics of persons with cognitive impairment being able to self-manage in chronic obstructive pulmonary disease (COPD). METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance this systematic review examined all studies in English from 1st January 2000 to 20 February 2016, describing the relationship between cognition and COPD self-management domains in older community dwelling persons with dementia or cognitive impairment. RESULTS Of 4474 studies identified, thirteen studies were eligible for inclusion. No studies differentiated populations into recognized dementia subtypes. Study aims were variable; most (n = 7) examined inhaler competency alone. Studies identified a link between worsening cognition and the need for assistance in activities of daily living. Only one study evaluated the impact of cognition on overall self-management and found no association between cognitive impairment and self-rated self-management. Mild degrees of cognitive impairment were associated with reduced symptom recall. Cognitive impairment in COPD was associated with high degrees of inhaler incompetency. Basic cognitive screening tests were able to predict inhaler incompetence with reduced overall cognitive function, dyspraxia, and/or executive function identified as predictors of incompetency. CONCLUSIONS Multiple measures of disability consistently demonstrated that cognitive impairment in COPD significantly increased the need for assistance in many aspects of daily living, treatment adherence, and effective self-management. Given the nature of neuropsychological deficits seen in COPD, dedicated screening tools are required. Future research should investigate the impact of cognitive dysfunction in COPD and identify how to support those that lack capacity to self-manage.
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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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Ihle A, Oris M, Fagot D, Chicherio C, van der Linden BWA, Sauter J, Kliegel M. Associations of educational attainment and cognitive level of job with old age verbal ability and processing speed: The mediating role of chronic diseases. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 25:356-362. [PMID: 28368656 DOI: 10.1080/23279095.2017.1306525] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated whether the relation of educational attainment and cognitive level of job to performance in verbal ability and processing speed in old age was mediated via the number of chronic diseases. A total of 2,812 older adults participated. Psychometric tests on verbal ability and processing speed were administered. Individuals were interviewed regarding their education, midlife occupation, and chronic diseases in old age. Higher educational attainment and higher cognitive level of job were correlated with better performance in verbal ability and processing speed (.15 ≤ r ≤ .33, ps < .001). 1.4 to 7.3% of these relations was mediated via the number of chronic diseases (β = .01, ps < .026). In conclusion, individuals with higher educational attainment and higher cognitive level of job may possibly suffer from fewer chronic diseases later in life. Possibly, this may finally be related to better performance in verbal ability and processing speed in those individuals in old age.
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Affiliation(s)
- Andreas Ihle
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland
| | - Michel Oris
- b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland
| | - Delphine Fagot
- b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland
| | - Christian Chicherio
- b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland.,c Neuropsychology Unit, Neurology Clinic, Department of Clinical Neurosciences , Geneva University Hospitals , Geneva , Switzerland
| | - Bernadette W A van der Linden
- b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland
| | - Julia Sauter
- b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland
| | - Matthias Kliegel
- a Department of Psychology , University of Geneva , Geneva , Switzerland.,b Center for the Interdisciplinary Study of Gerontology and Vulnerability , University of Geneva , Geneva , Switzerland
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Ouellette DR, Lavoie KL. Recognition, diagnosis, and treatment of cognitive and psychiatric disorders in patients with COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:639-650. [PMID: 28243081 PMCID: PMC5317263 DOI: 10.2147/copd.s123994] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
COPD is highly prevalent and associated with substantial morbidity and mortality. Clinicians have long been aware that patients with COPD have problems with cognition and are susceptible to mood (depression) and anxiety disorders. With the increasing awareness of COPD as a multisystem disorder, many studies have evaluated the prevalence of neuropsychiatric conditions in patients with COPD. This review presents evidence regarding the prevalence of neuropsychiatric conditions (cognitive disorders/impairment, depression/anxiety) in COPD, their risk factors, and their impact on relevant outcomes. It also discusses both assessment and treatment of neuropsychiatric conditions and makes recommendations for improved screening and treatment. The findings suggest that clinicians caring for patients with COPD must become familiar with diagnosing these comorbid conditions and that future treatment has the potential to impact these patients and thereby improve COPD outcomes.
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Affiliation(s)
- Daniel R Ouellette
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kim L Lavoie
- Montreal Behavioral Medicine Center (MBMC), Research Center, Integrated University Health and Social Services Center - Sacred Heart Hospital of Montreal, Montreal, QC, Canada
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Wise RA, Acevedo RA, Anzueto AR, Hanania NA, Martinez FJ, Ohar JA, Tashkin DP. Guiding Principles for the Use of Nebulized Long-Acting Beta2-Agonists in Patients with COPD: An Expert Panel Consensus. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2016; 4:7-20. [PMID: 28848907 DOI: 10.15326/jcopdf.4.1.2016.0141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Determining which patients with COPD may benefit from a nebulized long-acting beta2-agonist (LABA) is a challenge in current practice. In the absence of strong clinical guidelines addressing this issue, an expert panel convened to develop guiding principles for the use of nebulized LABA therapy in patients with COPD. This article summarizes these guiding principles and other practical issues discussed during a roundtable meeting.
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Affiliation(s)
- Robert A Wise
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Antonio R Anzueto
- University of Texas Health Science Center, and South Texas Veterans Health Care System, San Antonio, Texas
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Jill A Ohar
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Donald P Tashkin
- David Geffen School of Medicine at the University of California, Los Angeles
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Dal Negro RW, Povero M. The economic impact of educational training assessed by the Handling Questionnaire with three inhalation devices in asthma and Chronic Obstructive Pulmonary Disease patients. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:171-6. [PMID: 27274291 PMCID: PMC4869654 DOI: 10.2147/ceor.s104066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The usability of inhalation devices depends on several factors, eg, the drug to inhale, device handling, and patients’ training. Usability is then presumed to have economic consequences. Aim To assess and compare the cost of patients’ training for proper usability of Breezhaler and Genuair (both dry powder inhalers) and Respimat (a soft mist inhaler) in asthma and chronic obstructive pulmonary disease (COPD) outpatients. Methods The acceptance and handling of the three devices were investigated by means of the Handling Questionnaire. The time spent in specific training for ensuring a proper actuation and the corresponding costs were also calculated. Linear and logistic regressions were used in order to investigate the factors influencing proper handling of the devices. A significance level of P<0.05 was accepted. Results According to both the patients’ and the nurse’s judgments, Genuair and Respimat were perceived as the easiest devices to use, while Breezhaler required the highest number of attempts for achieving the first proper actuation (2.6 vs 1.6; P<0.0001). The total training cost per patient (including the nurse’s time for demonstration and that for attending the patients’ maneuvers) was €1.38±€1.21. Breezhaler was found to be the most expensive as the cost per patient was €2.35±€1.26, which was three to four times higher than that of Genuair and Respimat (both devices involved a cost of <€1 per patient, with negligible differences between each other). Asthma and COPD patients showed a similar trend, with better outcomes reported for asthma patients probably due to lower age. Conclusion Substantial differences were found to exist in patients’ acceptability and handling of the three devices. The economic impact of specific training was also different and strictly related to the comprehension of the procedure for actuation of each device. Respimat as a soft mist inhaler and Genuair as an metered-dose inhaler proved to be the most convenient in economic terms also.
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Affiliation(s)
- Roberto W Dal Negro
- National Centre for Respiratory Phamacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy
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31
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Lauridsen MM, Poulsen L, Rasmussen CK, Høgild M, Nielsen MK, de Muckadell OBS, Vilstrup H. Effects of common chronic medical conditions on psychometric tests used to diagnose minimal hepatic encephalopathy. Metab Brain Dis 2016; 31:267-72. [PMID: 26435407 DOI: 10.1007/s11011-015-9741-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/24/2015] [Indexed: 02/03/2023]
Abstract
Many chronic medical conditions are accompanied by cognitive disturbances but these have only to a very limited extent been psychometrically quantified. An exception is liver cirrhosis where hepatic encephalopathy is an inherent risk and mild forms are diagnosed by psychometric tests. The preferred diagnostic test battery in cirrhosis is often the Continuous Reaction Time (CRT) and the Portosystemic Encephalopathy (PSE) tests but the effect on these of other medical conditions is not known. We aimed to examine the effects of common chronic (non-cirrhosis) medical conditions on the CRT and PSE tests. We studied 15 patients with heart failure (HF), 15 with end stage renal failure (ESRF), 15 with dysregulated type II diabetes (DMII), 15 with chronic obstructive pulmonary disease (COPD), and 15 healthy persons. We applied the CRT test, which is a 10-min computerized test measuring sustained attention and reaction time stability and the PSE test, which is a paper-pencil test battery consisting of 5 subtests. We found that a high fraction of the patients with HF (8/15, 0.002) or COPD (7/15, p = 0.006) had pathological CRT test results; and COPD patients also frequently had an abnormal PSE test result (6/15, p < 0.0001). Both tests were unaffected by ESRF and DMII. Half of the patients with HF or COPD had psychometrically measurable cognitive deficits, whereas those with ESRF or DMII had not. This adds to the understanding of the clinical consequences of chronic heart- and lung disease, and implies that the psychometric tests should be interpreted with great caution in cirrhosis patients with heart- or lung comorbidity.
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Affiliation(s)
- M M Lauridsen
- Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - L Poulsen
- Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | - C K Rasmussen
- Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | - M Høgild
- Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | - M K Nielsen
- Department of Gastroenterology, Hospital of South West Jutland, Finsensgade 35, 6700, Esbjerg, Denmark
| | | | - H Vilstrup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Nørrebrogade 44, 8200, Aarhus, Denmark
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Tudorache E, Oancea C, Avram C, Fira-Mladinescu O, Petrescu L, Timar B. Balance impairment and systemic inflammation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2015; 10:1847-52. [PMID: 26392759 PMCID: PMC4572735 DOI: 10.2147/copd.s89814] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background/purpose Chronic obstructive pulmonary disease (COPD), especially in severe forms, is commonly associated with systemic inflammation and balance impairment. The aim of our study was to evaluate the impact on equilibrium of stable and exacerbation (acute exacerbation of COPD [AECOPD]) phases of COPD and to investigate if there is a connection between lower extremity muscle weakness and systemic inflammation. Methods We enrolled 41 patients with COPD (22 stable and 19 in AECOPD) and 20 healthy subjects (control group), having no significant differences regarding the anthropometric data. We analyzed the differences in balance tests scores: Falls Efficacy Scale-International (FES-I) questionnaire, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, Single Leg Stance (SLS), 6-minute walking distance (6MWD), isometric knee extension (IKE) between these groups, and also the correlation between these scores and inflammatory biomarkers. Results The presence and severity of COPD was associated with significantly decreased score in IKE (P<0.001), 6MWD (P<0.001), SLS (P<0.001), and BBS (P<0.001), at the same time noting a significant increase in median TUG score across the studied groups (P<0.001). The AECOPD group vs stable group presented a significant increase in high-sensitive C-reactive protein (hs-CRP) levels (10.60 vs 4.01; P=0.003) and decrease in PaO2 (70.1 vs 59.1; P<0.001). We observed that both IKE scores were significantly and positive correlated with all the respiratory volumes. In both COPD groups, we observed that fibrinogen reversely and significantly correlated with the 6MWD, and FES-I questionnaire is correlated positively with TUG test. Hs-CRP correlated reversely with the walking test and SLS test, while correlating positively with TUG test and FES-I questionnaire. Conclusion According to this study, COPD in advanced and acute stages is associated with an increased history of falls, systemic inflammation, balance impairment, and lower extremity muscle weakness.
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Affiliation(s)
- Emanuela Tudorache
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Claudiu Avram
- Physical Education and Sport Faculty, West University of Timisoara, Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Lucian Petrescu
- Department of Cardiology, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Bogdan Timar
- Department of Biostatistics and Medical Informatics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
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Dal Negro RW, Bonadiman L, Turco P. Prevalence of different comorbidities in COPD patients by gender and GOLD stage. Multidiscip Respir Med 2015; 10:24. [PMID: 26246895 PMCID: PMC4525744 DOI: 10.1186/s40248-015-0023-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Several comorbidities frequently affect COPD progression. Aim of the study was to assess the prevalence of main comorbidities by gender and disease severity in a cohort of COPD patients referring for the first time to a specialist institution. METHODS The study was a non-interventional, cross-sectional investigation carried out via automatic and anonymous selection from the institutional data base over the period 2012-2015. Inclusion criteria were: subjects of both sex aged ≥40 years; diagnosis of COPD according to GOLD guidelines 2014; the availability of a complete clinical record file. Variables collected were: lung function; smoking history; BMI; the Charlson Comorbidity Index (CCI); number and kind of comorbidities for each patient. RESULTS At least one comorbidity of clinical relevance was found in 78.6 % of patients, but at least two in 68.8 %, and three or more were found in 47.9 % of subjects. Mean CCI was 3.4 ± 1.6sd. The overall prevalence was 2.6 comorbidities per patient, but 2.5 in males, and 3.0 in females, respectively (p < 0.05). Cardio-vascular disorders were the most frequent, but significantly more frequent in males (44.7 vs 30.7 %, respectively), while the metabolic, the digestive and the osteo-articular disorders were prevailing in females (12.4 vs 9.2; 14.2 vs 4.8, and 6.0 vs 3.8, respectively). In particular, chronic cor pumonale and arrhythmias mainly prevailed in men and congestive heart failure in females, while arterial hypertension resulted equally distributed. As concerning respiratory disorders, pneumonia, pleural effusions and chronic respiratory failure were more frequently found in men, while bronchiectasis and asthma-COPD overlap syndrome (ACOS) in females. Anaemia, gall bladder stones, osteoporosis and spontaneous fractures mostly prevailed in females, while gastric disorders of inflammatory origin and arthrosis were more frequent in males. Cognition disorders, dementia and signs of degenerative brain disorders were more frequently found in men, while depression in females. Finally, lung cancer was at the first place in men, but at the second in females. CONCLUSIONS All comorbidities increased their prevalence progressively up to the last stage of COPD severity, except the cardio-vascular and the metabolic ones which dropped in the IV GOLD stage, presumably due to the high mortality rate in this severe COPD stage. The gender-dependency of comorbidities was confirmed in general terms, even if lung cancer proved a dramatic increase almost independently of sex.
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Affiliation(s)
- R. W. Dal Negro
- />National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, CESFAR, Verona, Italy
- />CEMS, Specialist Medical Centre, Verona, Italy
| | | | - P. Turco
- />Research & Clinical Governance, Verona, Italy
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Dal Negro RW, Bonadiman L, Bricolo FP, Tognella S, Turco P. Cognitive dysfunction in severe chronic obstructive pulmonary disease (COPD) with or without Long-Term Oxygen Therapy (LTOT). Multidiscip Respir Med 2015; 10:17. [PMID: 25932326 PMCID: PMC4415443 DOI: 10.1186/s40248-015-0013-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/30/2015] [Indexed: 12/22/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition which can lead to comorbidities of variable severity, cognitive dysfunction included. The role of supplemental oxygen in preventing COPD-induced cognitive deterioration is still debated, but only episodically investigated. The aim of this study was to compare the cognitive pattern of hypoxemic COPD subjects treated with long-term oxygen (LTOT) to that of patients of comparable severity assuming oxygen on irregular basis, and to normal reference values. Methods Lung function, arterial blood gases, health status, and cognitive function measured by means of four psychometric tests focusing different domains of cognition (such as: MMSE, Clock test; TMT-A; TMT-B) were assessed in 146 well matched hypoxemic COPD patients (males n = 96, 66%; mean age = 70.5 ± 12.9). Seventy-three patients were assuming long-term oxygen (LTOT), while the remaining seventy-three were only using oxygen as needed (AN). Regarding statistics, t test and ANOVA (Duncan test) were used to analyze data, assuming a p < 0.05 as the lowest limit of significance. Results Even though all COPD patients showed a poorer psychometric profile vs corresponding normal reference values, LTOT patients showed a lower prevalence of severe deterioration in cognition. Also the extent of impairment was significantly lower in these patients when assessed by TMT-A and TMT-B (p < 0.012 and 0.001, respectively), but not when measured by MMSE and Clock test (both p = ns). Several domains of cognition are variably affected by persistent hypoxemia in COPD patients. A panel of psychometric tools is needed for identifying the pattern of cognitive dysfunctions in these patients. Memory and attention (functions assessed by MMSE and Clock test) are only mildly-moderately affected, while visual processing, reproduction of numeric sequences, cognition flexibility, and shifting capacity (functions assessed by TMT-A and TMT-B) are much more deteriorated (p < 0.012 and p < 0.001, respectively). Conclusions Only LTOT allows to preserve significantly (p < 0.022) cognitive functions from the COPD-induced deterioration. This assumption is of strategic value for COPD patients who are prescribed long-term oxygen because they frequently are not aware of the cognitive risks related to their condition.
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Affiliation(s)
- Roberto W Dal Negro
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy ; Research & Clinical Governance, Verona, Italy
| | - Luca Bonadiman
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy
| | - Fernanda P Bricolo
- National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy
| | - Silvia Tognella
- Lung Unit, Orlandi General Hospital, ULSS22 Regione, Veneto, Italy
| | - Paola Turco
- Research & Clinical Governance, Verona, Italy
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Dal Negro RW. Dry powder inhalers and the right things to remember: a concept review. Multidiscip Respir Med 2015; 10:13. [PMID: 25878791 PMCID: PMC4397837 DOI: 10.1186/s40248-015-0012-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 11/10/2022] Open
Abstract
Dry powder inhalers (DPIs) are widely and increasingly used in clinical practice because they represent a substantial advancement in inhalation technology. The effectiveness of a powdered drug to inhale depends on the inspiratory flow rate generated by the patient and on the turbulence produced by the intrinsic resistance of the DPI. While the inspiratory flow is variable with the patient's ability and conditions, the turbulence is differently sized within each device because depending of its technical design. There are higher - medium-, and low-resistance devices. With low-resistance DPIs, the disaggregation and the microdispersion of the drug highly depend on the patient's inhalation airflow rate, because the role of the resistance-induced turbulence is obviously negligible in these cases. This flow-rate dependency is minimized in the presence of a sufficient regimen of turbulence as in the case of medium-resistance DPIs. Both the disaggregation and the micro-dispersion of the powdered drug are optimized in these circumstances even in the absence of a maximal inspiratory flow rate. The low resistance DPIs should not be regarded as the best performer DPIs because their intrinsic low-resistance regimen requires a higher inspiratory airflow rate and effort, which frequently cannot be achieved by subjects suffering from a disease-induced airflow limitation. Only when the ratio between the inhalation flow rate and the DPI intrinsic resistance is balanced, the speed of the particulate, the distribution of the drug within the lung, and the variability of the effective inhaled dose are optimized.
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Affiliation(s)
- Roberto W Dal Negro
- National Center for Respiratory Pharmacoeconomics and Pharmacoepidemiology - CESFAR, Verona, Italy ; Research & Clinical Governance, Verona, Italy
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