The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD

Fiona A H M Cleutjens; Martijn A Spruit; Rudolf W H M Ponds; Lowie E G W Vanfleteren; Frits M E Franssen; Jeanette B Dijkstra; Candy Gijsen; Emiel F M Wouters; Daisy J A Janssen

doi:10.1016/j.jamda.2016.11.016

The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD

J Am Med Dir Assoc. 2017 May 1;18(5):420-426. doi: 10.1016/j.jamda.2016.11.016. Epub 2017 Jan 17.

Authors

Fiona A H M Cleutjens¹, Martijn A Spruit², Rudolf W H M Ponds³, Lowie E G W Vanfleteren⁴, Frits M E Franssen⁴, Jeanette B Dijkstra³, Candy Gijsen⁴, Emiel F M Wouters⁵, Daisy J A Janssen⁴

Affiliations

¹ Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands. Electronic address: fionacleutjens@ciro-horn.nl.
² Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
³ Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands.
⁴ Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
⁵ Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht UMC+, Maastricht, the Netherlands.

PMID: 28108209
DOI: 10.1016/j.jamda.2016.11.016

Abstract

Objectives: To compare changes in pulmonary rehabilitation (PR) dropout and outcomes between chronic obstructive pulmonary disease (COPD) patients with and without cognitive impairment.

Design: A cross-sectional observational study.

Setting: Patients with COPD were recruited from a PR centre in the Netherlands.

Participants: The study population consisted of 157 patients with clinically stable COPD who were referred for and completed PR.

Measurements: A comprehensive neuropsychological examination before start of PR was administered. Changes from baseline to PR completion in functional exercise capacity [6-minute walk test (6MWT)], disease-specific health status [COPD Assessment Test (CAT) and St George's Respiratory Questionnaire-COPD specific (SGRQ-C)], psychological well-being [Hospital Anxiety and Depression Scale (HADS)], COPD-related knowledge, and their need for information [Lung Information Needs Questionnaire (LINQ)] were compared between patients with and without cognitive impairment using independent samples t tests or Mann-Whitney U tests.

Results: Out of 157 patients with COPD [mean age 62.9 (9.4) years, forced expiratory volume in the first second 54.6% (22.9%) predicted], 24 patients (15.3%) did not complete PR. The dropout rate was worse in patients with cognitive impairment compared to those without cognitive impairment (23.3% and 10.3%, P = .03). Mean changes in PR outcomes after PR did not differ between completers with and without cognitive impairment. The proportion of patients with a clinically relevant improvement in 6MWT, CAT, SGRQ-C, HADS, and LINQ scores was comparable for patients with and without cognitive impairment.

Conclusion: PR is an effective treatment for patients with COPD and cognitive impairment. Yet patients with cognitive impairment are at increased risk for not completing the PR program.

Keywords: COPD; cognitive impairment; patient-related outcomes; pulmonary rehabilitation.

Publication types

Observational Study

MeSH terms

Aged
Cognitive Dysfunction*
Cross-Sectional Studies
Female
Forced Expiratory Volume
Humans
Male
Middle Aged
Netherlands
Pulmonary Disease, Chronic Obstructive / rehabilitation*
Quality of Life
Surveys and Questionnaires
Treatment Outcome