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

Abstract

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

The Relationship Between Anxiety, Depression and Treatment Adherence in Chronic Obstructive Pulmonary Disease: A Systematic Review

“…Findings regarding depression were clearer and more consistent, leading to the conclusion that this mood disorder (especially when severe) could probably have a negative influence on treatment adherence, direct 23,57,73 or mediated. 55,56,73,74 However, different measurements and definitions of depression and operationalization of adherence could have been confounding factors. Findings concerning anxiety, on the other hand, were less coherent.…”

“…74 Depression can lower selfconfidence and self-efficacy 55 and contribute to the negative effect of cognitive impairment on compliance. 56,73 The association seemed stronger if the patients have a history of depression and not a recent onset after COPD diagnosis. 54 On the contrary, improving adherence may reduce depression decreasing dyspnoea-related problems.…”

“…In other studies, it is been said that this effect can be due to anxiety lowering self-confidence and selfefficacy 55 or incrementing cognitive impairment in older patients. 56 This may increase the risk of COPD exacerbation. 54 These effects, however, were always considered in combination with depression, as anxiety rarely occurs alone.…”

“…The Morisky Medication Adherence Scale (MMAS), 82 a validated scale for adherence, was employed in four studies 25,[45][46][47] and cited in two reviews. 56,73 One of those 46 also used the Adherence Schedule in Chronic Obstructive Lung Disease -Revised (ASiCOLD-R). 83 Study 48 employed a short COPD Action Plan developed by the Family Physician Airway Group of Canadian Thoracic Society.…”

Atrazine Inhalation Worsen Pulmonary Fibrosis Regulating the Nuclear Factor-Erythroid 2-Related Factor (Nrf2) Pathways Inducing Brain Comorbidities

“…Recent studies additionally focused their attention on the role played by Nrf2 expression during PF, showing that it plays a particularly important role in the progression of this pathology [28,[42][43][44][45][46][47][48][49][50]. Additionally, in light of the fact that some studies have recently demonstrated strong connections between common extrapulmonary brain-related comorbidities, such as depression, anxiety and cognitive problems [51][52][53][54][55][56][57][58][59], we also evaluated for the first time the impact of ATR exposure on behavioral changes in animals subjected or not to bleomycin administration.…”