title: The Impact of Cognitive Impairment on Efficacy of Pulmonary Rehabilitation in Patients With COPD.
abstract: OBJECTIVE
  To compare changes in pulmonary rehabilitation (PR) dropout and outcomes between chronic obstructive pulmonary disease (COPD) patients with and without cognitive impairment.
  
  
  METHODS
  A cross-sectional observational study.
  
  
  METHODS
  Patients with COPD were recruited from a PR centre in the Netherlands.
  
  
  METHODS
  The study population consisted of 157 patients with clinically stable COPD who were referred for and completed PR.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands. Electronic address: fionacleutjens@ciro-horn.nl.
authors.forename: Fiona A H M
authors.initials: FAHM
authors.lastname: Cleutjens
authors.affiliation: 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.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.affiliation: Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands.
authors.forename: Rudolf W H M
authors.initials: RWHM
authors.lastname: Ponds
authors.affiliation: Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Lowie E G W
authors.initials: LEGW
authors.lastname: Vanfleteren
authors.affiliation: Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Frits M E
authors.initials: FME
authors.lastname: Franssen
authors.affiliation: Department of Medical Psychology, Maastricht UMC+/School for Mental Health and Neurosciences (MHeNS), Maastricht, the Netherlands.
authors.forename: Jeanette B
authors.initials: JB
authors.lastname: Dijkstra
authors.affiliation: Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Candy
authors.initials: C
authors.lastname: Gijsen
authors.affiliation: 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.
authors.forename: Emiel F M
authors.initials: EFM
authors.lastname: Wouters
authors.affiliation: Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.
authors.forename: Daisy J A
authors.initials: DJA
authors.lastname: Janssen
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction; D003430:Cross-Sectional Studies; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: COPD; cognitive impairment; patient-related outcomes; pulmonary rehabilitation