Chronic Obstructive Pulmonary Disease and Extrapulmonary Effects: Cognitive Impairment
Cognitive Impairment
DOI:
https://doi.org/10.31584/jhsmr.201829Keywords:
clinical assessment, cognitive function, cognitive impairment, comorbidities, COPDAbstract
Chronic Obstructive Pulmonary Disease (COPD) is a public health problem which is increasing worldwide. Comorbidities usually occur in patients with COPD because COPD affects the physiological functions in a systemic manner. It has been reported that the ratio of cognitive impairment in COPD patients is higher than that of age-matched populations. Cognitive impairment thus has been proposed as a clinical manifestation in patients with COPD. Understanding all aspects of COPD and the effects of cognitive impairment on health outcomes for COPD patients therefore is essential for developing a holistic treatment.
References
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29. O’Donnell DE. Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006;3:180-4.
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32. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006;28:1245-57.
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34. Yohannes AM. Disability in patients with COPD. Chest 2014;145:200-2.
35. van Eeden SF, Sin DD. Oxidative stress in chronic obstructive pulmonary disease: a lung and systemic process. Can Respir J 2013;20:27-9.
36. Rahman I, Morrison D, Donaldson K, MacNee W. Systemic oxidative stress in asthma, COPD, and smokers. Am J Respir Crit Care Med 1996;154:1055-60.
37. Pratico D, Basili S, Vieri M, Cordova C, Violi F, Fitzgerald GA. Chronic obstructive pulmonary disease is associated with an increase in urinary levels of isoprostane F2α-III, an index of oxidant. Am J Respir Crit Care Me 1998;158:1709-14.
38. Baarends EM, Schols AM, Pannemans DL, Westerterp KR, Wouters EF. Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;155:549-54.
39. Hugli O, Schutz Y, Fitting JW. The daily energy expenditure in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:294-300.
40. Agusti AG, Sauleda J, Miralles C, Gomez C, Togores B, Sala E, et al. Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166:485-9.
41. Gosker HR, Wouters EF, van der Vusse GJ, Schols AM. Skeletal muscle dysfunction in COPD and chronic heart failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr 2000; 71:1033-47.
42. Jones NL, Killian KJ. Mechanisms of disease: exercise limitation in health and disease. N Engl J Med 2000;343:632-41.
43. Engelen MP, Schols AM, Lamers RJ, Wouters EF. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr 1999;18:275-80.
44. Gross NJ. Extrapulmonary effects of chronic obstructive pulmonary disease. Curr Opin Pulm Med 2001;7:84-92.
45. Takabatake N, Nakamura H, Minamihaba O, Inage M, Inoue S, Kagaya S, et al. A novel pathophysiologic phenomenon in cachexic patients with chronic obstructive pulmonary disease: the relationship between the circadian rhythm of circulating leptin and the very low-frequency component of heart rate variability. Am J Respir Crit Care Med 2001;163:1314-9.
46. Yoshida T, Tuder MR. Pathobiology of cigarette smoke induced chronic obstructive pulmonary disease. Physiol Rev 2007;87:1047-82.
47. Duong T, Acton PJ, Johnson RA. The in vitro neuronal toxicity of pentraxins associated with Alzheimer’s disease brain lesions. Brain Res 1998;813:303-12.
48. Ortapamuk H, Naldoken S. Brain perfusion abnormalities in chronic obstructive pulmonary disease: comparison with cognitive impairment. Ann Nucl Med 2006;20:99-106.
49. Mathur R, Cox IJ, Oatridge A, Shephard DT, Shaw RJ, Taylor Robinson SD. Cerebral bioenergetics in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160: 1994-9.
50. Rabins PV, Blacker D, Rovner BW, Rummans T, Schneider LS, Tariot PN, et al. American psychiatric association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Second edition. Am J Psychiatry 2007;164(Suppl 12):S5-56.
51. Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA 2014;312:2551-61.
52. Kozora E, Filley CM, Julian LJ, Cullum CM. Cognitive functioning in patients with chronic obstructive pulmonary disease and mild hypoxemia compared with patients with mild Alzheimer disease and normal controls. Neuropsychiatry Neuropsychol Behav Neurol 1999;12:178-83.
53. Fioravanti M, Nacca D, Amati S, Buckley AE, Bisetti A. Chronic obstructive pulmonary disease and associated patterns of memory decline. Dementia 1995;6:39-48.
54. Karamanli H, Ilik F, Kayhan F, Pazarli AC. Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10:2087-94.
55. Hung WW, Wisnivesky JP, Siu AL, Ross JS. Cognitive decline among patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;180:134-7.
56. Schou L, Ostergaard B, Rasmussen LS, Rydahl-Hansen S, Phanareth K. Cognitive dysfunction in patients with chronic obstructive pulmonary disease-a systematic review. Respir Med 2012;106:1071-81.
57. Allaire JC, Gamaldo A, Ayotte BJ, Sims R, Whitfield K. Mild cognitive impairment and objective instrumental everyday functioning: the everyday cognition battery memory test. J Am Geriatr Soc 2009;57:120-5.
58. Allen SC, Jain M, Ragab S, Malik N. Acquisition and short term retention of inhaler techniques require intact executive function in elderly subjects. Age Ageing 2003;32:299-302.
59. Incalzi RA, Corsonello A, Pedone C, Corica F, Carbonin P, Bernabei R, et al. Construct validity of activities of daily living scale: a clue to distinguish the disabling effects of COPD and congestive heart failure. Chest 2005;127:830-8.
60. Antonelli-Incalzi R. Corsonello A. Trojano L, Acanfora D, Spada A, Izzo O, et al. Correlation between cognitive impairment and dependence in hypoxemic COPD. J Clin Exp Neuropsychol 2008;30:141-50.
61. Ranieri P, Bianchetti A, Margiotta A, Virgillo A, Clini EM, Trabucchi M. Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. J Am Geriatr Soc 2008;56:909-13.
62. Ambrosino N, Bruletti G, Scala V, Porta R, Vitacca M. Cognitive and perceived health status in patient with chronic obstructive pulmonary disease surviving acute on chronic respiratory failure: a controlled study. Intensive Care Med 2002;28:170-7.
63. Karamanli H, Ilik F, Kayhan F, Pazarli AC. Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10: 2087-94.
64. Villeneuve S, Pepin V, Rahayel S, Bertrand JA, de Lorimier M, Rizk A, et al. Mild cognitive impairment in moderate to severe COPD: a preliminary study. Chest 2012;142:1516-23.
65. Crisan FA, Oancea C, Timar B, Fira-Mladinescu O, Crisan A, Tudorache V. Cognitive impairment in chronic obstructive pulmonary disease. Plos One 2014;9:1-6.
66. Yawn BP, Thomashow B. Management of patients during and after exacerbations of chronic obstructive pulmonary disease: the role of primary care physicians. Int J Gen Med 2011;4:665-76.
67. Hynninen KM, Breitve MH, Wiborg AB, Pallesen S, Nordhus IH. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res 2005;59:429-43.
68. Berry JM, Jack Rejeski W, Miller EM, Adair EN, Lang W, Foy CG, et al. A lifestyle activity intervention in patients with chronic obstructive pulmonary disease. Respir Med 2010;104:829-39.
69. Etnier J, Johnston R, Dagenbach D, Pollard RJ, Rejeski WJ, Berry M. The relationships among pulmonary function, aerobic fitness, and cognitive functioning in older COPD patients. Chest 1999;116:953-60.
70. Emery CF, Shermer RL, Hauck ER, Hsiao ET, MacIntyre NR. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol 2003;22:598-604.
71. Etnier JL, Berry M. Fluid intelligence in an older COPD sample after short- or long-term exercise. Med Sci Sports Exerc 2001;33:1620-8.
72. Emery CF, Honn VJ, Frid DJ, Lebowitz KR, Diaz PT. Acute effects of exercise on cognition in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:1624-7.
73. Cleutjens FAHM, Spruit MA, Ponds R WHM, Vanfleteren LEGW, Franssen FME, Dijkstra JB, et al. The impact of cognitive impairment on efficacy of pulmonary rehabilitation in patients with COPD. J Am Med Dir Assoc 2017;18:420-6.
74. Piya-amornphan N, Worawattanachai S, Jeenpracha T, Changni M, Tholee S, Damchuay T, et al. Cognitive improvement enhances cognitive function and physical function in patients with moderate to severe COPD: a preliminary study. J Thai Rehabil Med 2017;27:64-70.
2. World Health Organization. Chronic respiratory diseases [homepage on the internet]. Geneva: WHO; 2018 [cited 2018 Feb 12]. Available from: https://www.who.int/respiratory/en/
3. Ajmera M, Sambamoorthi U, Metzger A, Dwibedi N, Rust G, Tworek C. Multimorbidity and COPD medication receipt among medicaid beneficiaries with newly diagnosed COPD. Respir Care 2015;60:1592-602.
4. Vijayan VK. Chronic obstructive pulmonary disease. Indian J Med Res 2013;137:251-69.
5. Fried TR, Vaz Fragoso CA, Rabow MW. Caring for the older person with chronic obstructive pulmonary disease. JAMA 2012;308:1254-63.
6. Dodd JW, Getov SV, Jones PW. Cognitive function in COPD. Eur Respir J 2010;35:913-22.
7. Global Initiative for Chronic Obstructive Lung Disease. Pocket guide to COPD diagnosis, management, and prevention. A guide for health care professionals 2017 report [monograph on the Internet]. GOLD; 2017 [cited 2018 Feb 12]. Available from: https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD2017-Pocket-Guide.pdf
8. Viegi G, Pistelli F, Sherrill DL, Maio S, Baldacci S, Carrozzi L. Definition, epidemiology and natural history of COPD. Eur Respir J 2007;30:993-1013.
9. Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet 2016;388:1659-724.
10. Lange P, Celli B, Agusti A, Boje Jensen G, Divo M, Faner R, et al. Lung-function trajectories leading to chronic obstruc tive pulmonary disease. N Engl J Med 2015;373:111-22.
11. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Glob Health 2015. DOI: 10.7189/jogh.05-020415.
12. Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc 2007;4:502-6.
13. Chapman KR, Mannino DM, Soriano JB, Vermeire PA, Buist AS, Thun MJ, et al. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J 2006;27:188-207.
14. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006;28:523-32.
15. Ministry of Public Health. Office of the Permanent Secretary Strategy and Planning Division. Health data [homepage on the Internet]. Nonthaburi: The Ministry; 2016 [cited 2018 Feb 12]. Available from: https://bps.moph.go.th/new_bps/index.php
16. Rennard SI, Drummond MB. Early chronic obstructive pulmonary disease: definition, assessment, and prevention. Lancet 2015;385:1778-88.
17. Sorheim IC, Johannessen A, Gulsvik A, Bakke PS, Silverman EK, DeMeo DL. Gender differences in COPD: are women more susceptible to smoking effects than men? Thorax 2010;65:480-5.
18. Han MK, Postma D, Mannino DM, Giardino ND, Buist S, Curtis JL, et al. Gender and chronic obstructive pulmonary disease: why it matters. Am J Respir Crit Care Med 2007;176:1179-84.
19. Guarascio AJ, Ray SM, Finch CK, Self TH. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res 2013;5:235-45.
20. Miravitlles M, Ribera A. Understanding the impact of symptoms on the burden of COPD. Respir Res 2017. DOI 10.1186/s12931017-0548-3
21. Fabbri LM, Luppi F, Beghe B, Rabe KF. Complex chronic comorbidities of COPD. Eur Respir J 2008;31:204-12.
22. Bolton CE, Ionescu AA, Shiels KM, Pettit RJ, Edwards PH, Stone MD, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170:1286-93.
23. Agusti AG, Noguera A, Sauleda J, Sala E, Pons J, Busquets X. Systemic effects of chronic obstructive pulmonary disease. Eur Respir J 2003;21:347-60.
24. Vestbo J, Anderson J, Brook RD, Calverley PM, Celli BR, Crim C, et al. The Study to understand mortality and morbidity in COPD (SUMMIT) study protocol. Eur Respir J 2013;41:1017-22.
25. Holguin F, Folch E, Redd SC, Mannino DM. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest 2005;128:2005-11.
26. MacNee W. ABC of chronic obstructive pulmonary disease: pathology, pathogenesis, and pathophysiology. BMJ 2006;332:1202-4.
27. Kim KE. COPD heterogeneity and personalized treatment. In: Lee S, editor. Pathophysiology of COPD [monograph on the Internet]. Heidelberg: Springer; 2017 [cited 2018 Feb 15]. Available from: https://www.researchgate.net/publication/321502028_COPD_Heterogeneity_and_Personalized_Treatment
28. Cooper CB. The connection between chronic obstructive pulmonary disease symptoms and hyperinflation and its impact on exercise and function. Am J Med 2006;119(Suppl 1):S21-31.
29. O’Donnell DE. Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease. Proc Am Thorac Soc 2006;3:180-4.
30. Han MK, Muellerova H, Curran-Everett D, Dransfield MT, Washko GR, Regan EA, et al. GOLD 2011 disease severity classification in COPDGene: a prospective cohort study. Lancet Respir Med 2013;1:43-50.
31. Jones PW. Health status and the spiral of decline. COPD 2009;6:59-63.
32. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J 2006;28:1245-57.
33. Decramer M, De Benedetto F, Del Ponte A, Marinari S. Systemic effects of COPD. Respir Med 2005;99(Suppl B): S3-10.
34. Yohannes AM. Disability in patients with COPD. Chest 2014;145:200-2.
35. van Eeden SF, Sin DD. Oxidative stress in chronic obstructive pulmonary disease: a lung and systemic process. Can Respir J 2013;20:27-9.
36. Rahman I, Morrison D, Donaldson K, MacNee W. Systemic oxidative stress in asthma, COPD, and smokers. Am J Respir Crit Care Med 1996;154:1055-60.
37. Pratico D, Basili S, Vieri M, Cordova C, Violi F, Fitzgerald GA. Chronic obstructive pulmonary disease is associated with an increase in urinary levels of isoprostane F2α-III, an index of oxidant. Am J Respir Crit Care Me 1998;158:1709-14.
38. Baarends EM, Schols AM, Pannemans DL, Westerterp KR, Wouters EF. Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997;155:549-54.
39. Hugli O, Schutz Y, Fitting JW. The daily energy expenditure in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;153:294-300.
40. Agusti AG, Sauleda J, Miralles C, Gomez C, Togores B, Sala E, et al. Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002;166:485-9.
41. Gosker HR, Wouters EF, van der Vusse GJ, Schols AM. Skeletal muscle dysfunction in COPD and chronic heart failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr 2000; 71:1033-47.
42. Jones NL, Killian KJ. Mechanisms of disease: exercise limitation in health and disease. N Engl J Med 2000;343:632-41.
43. Engelen MP, Schols AM, Lamers RJ, Wouters EF. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr 1999;18:275-80.
44. Gross NJ. Extrapulmonary effects of chronic obstructive pulmonary disease. Curr Opin Pulm Med 2001;7:84-92.
45. Takabatake N, Nakamura H, Minamihaba O, Inage M, Inoue S, Kagaya S, et al. A novel pathophysiologic phenomenon in cachexic patients with chronic obstructive pulmonary disease: the relationship between the circadian rhythm of circulating leptin and the very low-frequency component of heart rate variability. Am J Respir Crit Care Med 2001;163:1314-9.
46. Yoshida T, Tuder MR. Pathobiology of cigarette smoke induced chronic obstructive pulmonary disease. Physiol Rev 2007;87:1047-82.
47. Duong T, Acton PJ, Johnson RA. The in vitro neuronal toxicity of pentraxins associated with Alzheimer’s disease brain lesions. Brain Res 1998;813:303-12.
48. Ortapamuk H, Naldoken S. Brain perfusion abnormalities in chronic obstructive pulmonary disease: comparison with cognitive impairment. Ann Nucl Med 2006;20:99-106.
49. Mathur R, Cox IJ, Oatridge A, Shephard DT, Shaw RJ, Taylor Robinson SD. Cerebral bioenergetics in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999;160: 1994-9.
50. Rabins PV, Blacker D, Rovner BW, Rummans T, Schneider LS, Tariot PN, et al. American psychiatric association practice guideline for the treatment of patients with Alzheimer’s disease and other dementias. Second edition. Am J Psychiatry 2007;164(Suppl 12):S5-56.
51. Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA 2014;312:2551-61.
52. Kozora E, Filley CM, Julian LJ, Cullum CM. Cognitive functioning in patients with chronic obstructive pulmonary disease and mild hypoxemia compared with patients with mild Alzheimer disease and normal controls. Neuropsychiatry Neuropsychol Behav Neurol 1999;12:178-83.
53. Fioravanti M, Nacca D, Amati S, Buckley AE, Bisetti A. Chronic obstructive pulmonary disease and associated patterns of memory decline. Dementia 1995;6:39-48.
54. Karamanli H, Ilik F, Kayhan F, Pazarli AC. Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10:2087-94.
55. Hung WW, Wisnivesky JP, Siu AL, Ross JS. Cognitive decline among patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009;180:134-7.
56. Schou L, Ostergaard B, Rasmussen LS, Rydahl-Hansen S, Phanareth K. Cognitive dysfunction in patients with chronic obstructive pulmonary disease-a systematic review. Respir Med 2012;106:1071-81.
57. Allaire JC, Gamaldo A, Ayotte BJ, Sims R, Whitfield K. Mild cognitive impairment and objective instrumental everyday functioning: the everyday cognition battery memory test. J Am Geriatr Soc 2009;57:120-5.
58. Allen SC, Jain M, Ragab S, Malik N. Acquisition and short term retention of inhaler techniques require intact executive function in elderly subjects. Age Ageing 2003;32:299-302.
59. Incalzi RA, Corsonello A, Pedone C, Corica F, Carbonin P, Bernabei R, et al. Construct validity of activities of daily living scale: a clue to distinguish the disabling effects of COPD and congestive heart failure. Chest 2005;127:830-8.
60. Antonelli-Incalzi R. Corsonello A. Trojano L, Acanfora D, Spada A, Izzo O, et al. Correlation between cognitive impairment and dependence in hypoxemic COPD. J Clin Exp Neuropsychol 2008;30:141-50.
61. Ranieri P, Bianchetti A, Margiotta A, Virgillo A, Clini EM, Trabucchi M. Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. J Am Geriatr Soc 2008;56:909-13.
62. Ambrosino N, Bruletti G, Scala V, Porta R, Vitacca M. Cognitive and perceived health status in patient with chronic obstructive pulmonary disease surviving acute on chronic respiratory failure: a controlled study. Intensive Care Med 2002;28:170-7.
63. Karamanli H, Ilik F, Kayhan F, Pazarli AC. Assessment of cognitive impairment in long-term oxygen therapy-dependent COPD patients. Int J Chron Obstruct Pulmon Dis 2015;10: 2087-94.
64. Villeneuve S, Pepin V, Rahayel S, Bertrand JA, de Lorimier M, Rizk A, et al. Mild cognitive impairment in moderate to severe COPD: a preliminary study. Chest 2012;142:1516-23.
65. Crisan FA, Oancea C, Timar B, Fira-Mladinescu O, Crisan A, Tudorache V. Cognitive impairment in chronic obstructive pulmonary disease. Plos One 2014;9:1-6.
66. Yawn BP, Thomashow B. Management of patients during and after exacerbations of chronic obstructive pulmonary disease: the role of primary care physicians. Int J Gen Med 2011;4:665-76.
67. Hynninen KM, Breitve MH, Wiborg AB, Pallesen S, Nordhus IH. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res 2005;59:429-43.
68. Berry JM, Jack Rejeski W, Miller EM, Adair EN, Lang W, Foy CG, et al. A lifestyle activity intervention in patients with chronic obstructive pulmonary disease. Respir Med 2010;104:829-39.
69. Etnier J, Johnston R, Dagenbach D, Pollard RJ, Rejeski WJ, Berry M. The relationships among pulmonary function, aerobic fitness, and cognitive functioning in older COPD patients. Chest 1999;116:953-60.
70. Emery CF, Shermer RL, Hauck ER, Hsiao ET, MacIntyre NR. Cognitive and psychological outcomes of exercise in a 1-year follow-up study of patients with chronic obstructive pulmonary disease. Health Psychol 2003;22:598-604.
71. Etnier JL, Berry M. Fluid intelligence in an older COPD sample after short- or long-term exercise. Med Sci Sports Exerc 2001;33:1620-8.
72. Emery CF, Honn VJ, Frid DJ, Lebowitz KR, Diaz PT. Acute effects of exercise on cognition in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001;164:1624-7.
73. Cleutjens FAHM, Spruit MA, Ponds R WHM, Vanfleteren LEGW, Franssen FME, Dijkstra JB, et al. The impact of cognitive impairment on efficacy of pulmonary rehabilitation in patients with COPD. J Am Med Dir Assoc 2017;18:420-6.
74. Piya-amornphan N, Worawattanachai S, Jeenpracha T, Changni M, Tholee S, Damchuay T, et al. Cognitive improvement enhances cognitive function and physical function in patients with moderate to severe COPD: a preliminary study. J Thai Rehabil Med 2017;27:64-70.
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2018-10-22
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Piya-amornphan N, Santiworakul A, Nawarat J. Chronic Obstructive Pulmonary Disease and Extrapulmonary Effects: Cognitive Impairment: Cognitive Impairment. J Health Sci Med Res [Internet]. 2018 Oct. 22 [cited 2024 Apr. 25];36(4):323-3. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/133088
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