<p>Mid-Term Effects of Pulmonary Rehabilitation on Cognitive Function in People with Severe Chronic Obstructive Pulmonary Disease</p>

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 FEV 1 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.

Cognitive function following pulmonary rehabilitation and post-discharge recovery from exacerbation in people with COPD

“…Although we saw no improvement in cognition for the whole PR group, our results are in line with Bonnevie et al [25] who found cognitive improvements following PR in people with COPD and CI. Previous studies investigated the effect of more intensive PR programmes, such as a 3-week in-patient programme (5-6 sessions/week) [23] or an 8-week programme (3 sessions/week) [25]. We have been able to observe the same cognitive changes in people with COPD and CI following a less intensive PR programme.…”

“…PR has many benefits for people living with COPD [19], and more recently studies have demonstrated the positive effects of PR on cognitive status using the MoCA [23,25]. Although we saw no improvement in cognition for the whole PR group, our results are in line with Bonnevie et al [25] who found cognitive improvements following PR in people with COPD and CI.…”

“…PR has many benefits for people living with COPD [19], and more recently studies have demonstrated the positive effects of PR on cognitive status using the MoCA [23,25]. Although we saw no improvement in cognition for the whole PR group, our results are in line with Bonnevie et al [25] who found cognitive improvements following PR in people with COPD and CI. Previous studies investigated the effect of more intensive PR programmes, such as a 3-week in-patient programme (5-6 sessions/week) [23] or an 8-week programme (3 sessions/week) [25].…”

“…PR has been shown to improve symptoms, exercise capacity and health-related quality of life for both groups of patients [19,20]. Evidence suggests that PR leads to an improvement in cognition in people experiencing stable COPD symptoms [21][22][23][24][25], but we know that low uptake to PR remains a challenge, with a 15.2% acceptance rate [26]. It is recommended that patients in the post-AECOPD phase attend PR within 4 weeks of being discharged [27], however PR uptake in this population is known to be even lower, with only 2% being referred [26] and even fewer attending and completing PR [28][29][30].…”

Measurement properties of step tests for exercise capacity in COPD: A systematic review

“…Eleven articles included validity, 29 , 31 – 40 seven articles included reliability, 30 , 31 , 33 , 35 , 41 – 43 13 articles included responsiveness, 36 , 37 , 43 – 53 and five articles included interpretability 33 , 34 , 37 , 54 , 55 of the step tests. Details on each article included in this review are presented in Supplemental Appendix 3.…”