P41 Pulmonary rehabilitation can improve cognitive impairment in COPD patients

• Published in: Thorax Vol. 76; no. Suppl 1; p. A107
• Main Authors: France, G, Orme, MW, Greening, NJ, Steiner, MC, Singh, SJ
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.02.2021
• Subjects: Anxiety; Chronic obstructive pulmonary disease; Cognition & reasoning; Cognitive ability
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2020-BTSabstracts.186

BackgroundAn acute exacerbation of COPD (AECOPD) causes deterioration in health and cognition, and although the symptomatic recovery post-hospitalisation is well documented, less is known regarding the recovery of cognition. Pulmonary rehabilitation (PR) is an established intervention for patients with COPD, in both the post-AECOPD and stable phase. PR is known to improve symptoms and health-related quality of life but the effect of PR on cognition is not well understood.AimsTo examine the recovery of cognition and other health-related outcomes following discharge after hospitalisation for AECOPD, and following PR in COPD patients with stable symptoms.MethodsAECOPD patients were assessed during hospital stay and at 6 weeks post-discharge and stable COPD patients were assessed before and after a 6 week PR programme. All patients were evaluated for cognition (Montreal Cognitive Assessment (MoCA), with cognitive impairment defined as <26/30), psychological well-being (HADS), COPD symptoms (CAT and CRQ) and physical function (Short Physical Performance Battery (SPPB)). Data were analysed using paired t-tests.Results28 AECOPD patients (mean±SD, age 67±9 yrs, 16 male) were recruited. At 6 weeks, a significant improvement was seen in depression, anxiety, COPD symptoms and physical function but there was no improvement in cognition (MoCA: 24.0±3.8 vs 23.25±3.7, p=0.21). 42 stable COPD patients were recruited and PR resulted in an improvement in symptoms of anxiety (Δ2.0±3.6, p=0.002), CAT (Δ3.0±4.9, p<0.001), SPPB (Δ0.9±1.2, p<0.001), CRQ-Dyspnoea (Δ0.8±1.4, p<0.001), CRQ-Emotion (Δ0.7±1.3, p=0.001), CRQ-Mastery (Δ0.8±1.4, p=0.001) and CRQ-Fatigue (Δ0.7±1.1, p<0.001), but no change in MoCA or symptoms of depression (figure 1A). Patients with cognitive impairment at baseline showed a significant increase in MoCA score following PR (Δ1.6±2.4, p=0.004), with no significant change for the NCI group (Δ-0.8±2.8, p=0.276) (figure 1B).Abstract P41 Figure 1A: Change in outcome measures following PR; B: MoCA Score for cognitively impaired and non-cognitively impaired patients following PR (error bars represent 95% Cl; all p<0.05)ConclusionsFor AECOPD patients, cognition did not improve post-hospitalisation despite improvements in symptoms, physical function and health status over 6 weeks. PR showed an improvement in anxiety, physical function and respiratory symptoms, and for those who were cognitively impaired, PR resulted in an improvement in cognition. Due to the lack of natural recovery of cognition post-hospitalisation, AECOPD patients should be actively encouraged to attend and complete PR.