Mild cognitive impairment (MCI), also known as incipient dementia, is characterized by the decline of cognitive function greater than expected for a certain age and educational level of the individual but not severe enough to interfere with their daily activities. However, this mild cognitive impairment affects several areas: visuospatial, memory, attention and fluency and it is a significant concern because it decreases the quality of life and treatment adherence of these patients. On the other hand, evidence suggests that individuals with Chronic obstructive pulmonary disease (COPD) also present an important risk of falls: 46% of these patients experience a fall/year, sometimes with fatal consequences. Standard clinical balance measures can predict the risk of falls in this population. Moreover, increased inflammatory biomarkers are associated with the decrease of cognitive functions and a higher risk of falls in this population. Patients with COPD have a higher balance and cognitive impairment than their healthy peers Therefore, it is important to identify, assess and understand the relevance of these comorbidities in order to characterize the full clinical spectrum of COPD and adjust prevention strategies, given the devastating consequences of these problems.
Part of the book: COPD
Idiopathic pulmonary fibrosis (IPF) is known as one of the most severe lung conditions and the worst form of interstitial lung disease (ILD). There is a continuing concern about clinical research to identify new therapies that influence the quality of life in patients diagnosed with this chronic progressive pulmonary disease, with an average survival of 3–5 years. Although in recent years great progress has been made to slow down the functional decline of the disease with new antifibrotic therapies, it has failed to alter the prognosis and survival of IPF patients. Clinical trials and recent ATS/ERS guidelines have brought at least moderate and low levels of evidence for increased effort tolerance, decreased symptoms, and improved quality of life following participation in lung rehabilitation programs for ILD patients and in particular those with IPF. Pulmonary rehabilitation has been shown to be a standard of care for COPD patients, but their personalized application to patients with IPF has had positive short-term results, becoming a safe alternative to non-pharmacological treatment. The chapter includes the general objectives of rehabilitation programs, their type and structure, ways of complex assessment of patients before and after a training exercise, types of exercises, and short- and long-term results.
Part of the book: Interstitial Lung Diseases
The increase in life expectancy has been accompanied by an escalation of age-related disease incidence. Mild cognitive impairment (MCI) is a decline of cognitive function higher than expected for a certain age, but not severe enough to meet the criteria for dementia. Hypoxemia, smoking history, ageing and several comorbidities are risk factors for both chronic respiratory diseases and cognitive deficit. Up to 70% of patients with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA) or idiopathic pulmonary fibrosis (IPF) have a form of cognitive impairment. Furthermore, a low neuropsychological performance is an independent predictor of disability and mortality in these populations. Efficient tools for cognitive assessment have been validated for these patients and should be used for better clinical outcomes. The physiopathological mechanisms, clinical impact and prevention strategies for cognitive dysfunction in chronic respiratory diseases will be detailed in the following chapter.
Part of the book: An Overview and Management of Multiple Chronic Conditions