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      Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment?

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          Abstract

          Cognitive impairment is highly prevalent in patients with COPD and demonstrates multiple detrimental effects on many aspects of patient state and therapeutic outcomes. It is attributed to several overlapping pathophysiological factors, with the most common being the low level of oxygen saturation due to respiratory insufficiency. Despite the impact of cognitive impairment on clinical outcomes, the screening for coexisting cognitive deficits which may interfere with the successful progress of respiratory treatment is yet neglected. There is a special consideration that cognitive deficits should be taken into account when developing respiratory therapy plans. Cognitively impaired patients are likely to require more support and have need of an individualised respiratory care plan which can also be beneficial for their cognitive deficits. Pulmonary rehabilitation as a multidisciplinary approach could be prioritised for COPD patients with cognitive impairment.

          Educational aims

          • To illustrate the common signs of cognitive impairment and define potential associations between lung and cognitive dysfunction.

          • To illustrate the potential influence of cognitive deficits on the optimal progress of respiratory therapy.

          • To illustrate the importance of cognitive evaluation as part of a comprehensive clinical assessment for patients suspected of suffering cognitive impairment.

          Abstract

          Cognitive impairment in COPD may affect respiratory treatment and should be considered in therapeutic strategy http://ow.ly/aK3s309RiS9

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          Most cited references58

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          A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia.

          To validate a simple bedside test battery designed to detect mild dementia and differentiate AD from frontotemporal dementia (FTD). Addenbrooke's Cognitive Examination (ACE) is a 100-point test battery that assesses six cognitive domains. Of 210 new patients attending a memory clinic, 139 fulfilled inclusion criteria and comprised dementia (n = 115) and nondementia (n = 24) groups. The composite and the component scores on the ACE for the two groups were compared with those of 127 age- and education-matched controls. Norms and the probability of diagnosing dementia at different prevalence rates were calculated. To evaluate the ACE's ability to differentiate early AD from FTD, scores of the cases diagnosed with dementia with a Clinical Dementia Rating 3.2 for AD was highly discriminating. The ACE is a brief and reliable bedside instrument for early detection of dementia, and offers a simple objective index to differentiate AD and FTD in mildly demented patients.
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            The influence of exercise on cognitive abilities.

            Scientific evidence based on neuroimaging approaches over the last decade has demonstrated the efficacy of physical activity improving cognitive health across the human lifespan. Aerobic fitness spares age-related loss of brain tissue during aging, and enhances functional aspects of higher order regions involved in the control of cognition. More active or higher fit individuals are capable of allocating greater attentional resources toward the environment and are able to process information more quickly. These data are suggestive that aerobic fitness enhances cognitive strategies enabling to respond effectively to an imposed challenge with a better yield in task performance. In turn, animal studies have shown that exercise has a benevolent action on health and plasticity of the nervous system. New evidence indicates that exercise exerts its effects on cognition by affecting molecular events related to the management of energy metabolism and synaptic plasticity. An important instigator in the molecular machinery stimulated by exercise is brain-derived neurotrophic factor, which acts at the interface of metabolism and plasticity. Recent studies show that exercise collaborates with other aspects of lifestyle to influence the molecular substrates of cognition. In particular, select dietary factors share similar mechanisms with exercise, and in some cases they can complement the action of exercise. Therefore, exercise and dietary management appear as a noninvasive and effective strategy to counteract neurological and cognitive disorders.
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              Medication adherence issues in patients treated for COPD

              Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient’s selection of both the device and the regimen. Patient’s health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence.
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                Author and article information

                Journal
                Breathe (Sheff)
                Breathe (Sheff)
                BREATHE
                breathe
                Breathe
                European Respiratory Society
                1810-6838
                2073-4735
                March 2017
                : 13
                : 1
                : e1-e9
                Affiliations
                [1 ]Dept of Respiratory Medicine and Pulmonary Rehabilitation, Schön Klinik Berchtesgadener Land, Schönau am Königssee, Germany
                [2 ]Dept for Prevention, Rehabilitation and Sports Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
                [3 ]Dept of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
                [4 ]Dept of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
                [5 ]Dept of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany
                Author notes
                Article
                EDU-0014-2017
                10.1183/20734735.001417
                5702891
                29184593
                881940b6-7fb0-4c7d-ae20-7671e697334e
                Copyright ©ERS 2017

                Breathe articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 31 January 2017
                : 13 February 2017
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