Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

doi:10.1016/j.chest.2024.05.027

Review

. 2024 Oct;166(4):721-732.

doi: 10.1016/j.chest.2024.05.027. Epub 2024 Jun 18.

Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

Dmitry Rozenberg¹, W Darlene Reid², Pat Camp³, Jennifer L Campos⁴, Gail Dechman⁵, Paul W Davenport⁶, Helga Egan⁷, Jolene H Fisher⁸, Jordan A Guenette⁹, David Gold¹⁰, Roger S Goldstein¹¹, Donna Goodridge¹², Tania Janaudis-Ferreira¹³, Alan G Kaplan¹⁴, Daniel Langer¹⁵, Darcy D Marciniuk¹⁶, Barbara Moore⁷, Ani Orchanian-Cheff¹⁷, Jessica Otoo-Appiah¹⁸, Veronique Pepin¹⁹, Peter Rassam²⁰, Shlomit Rotenberg²¹, Chris Ryerson²², Martijn A Spruit²³, Matthew B Stanbrook⁸, Michael K Stickland²⁴, Jeannie Tom⁷, Kirsten Wentlandt²⁵

Affiliations

¹ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. Electronic address: Dmitry.Rozenberg@uhn.ca.
² Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
³ Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, BC, Canada.
⁴ KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada.
⁵ School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; Department of Medicine, Respirology, Nova Scotia Health Authority, Halifax, NS, Canada.
⁶ Department of Physiological Sciences, University of Florida, Gainesville, FL.
⁷ Lung Health Foundation, Toronto, ON, Canada.
⁸ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada.
⁹ Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada; Division of Respiratory Medicine, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada.
¹⁰ Department of Psychiatry, Krembil Brain Institute, University of Toronto, Toronto, ON, Canada; Neuropsychology Clinic, University Health Network, Toronto, ON, Canada.
¹¹ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, ON, Canada; Department of Respiratory Medicine, Westpark Healthcare Centre, Toronto, ON, Canada.
¹² College of Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada.
¹³ School of Physical & Occupational Therapy, McGill University, Montreal, QB, Canada.
¹⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Family Physician Airways Group of Canada, Markham, ON, Canada.
¹⁵ KU Leuven, Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium; Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
¹⁶ Division of Respirology, Critical Care and Sleep Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada.
¹⁷ Library and Information Services, University Health Network, Toronto, ON, Canada.
¹⁸ Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QB, Canada.
²⁰ Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
²¹ Department of Occupational Science & Occupational Therapy, and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest, Toronto, ON, Canada.
²² Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
²³ Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
²⁴ Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada.
²⁵ Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Supportive Care, University Health Network, Toronto, ON, Canada.

PMID: 38901488
PMCID: PMC11489522
DOI: 10.1016/j.chest.2024.05.027

Review

Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

Dmitry Rozenberg et al. Chest. 2024 Oct.

. 2024 Oct;166(4):721-732.

doi: 10.1016/j.chest.2024.05.027. Epub 2024 Jun 18.

Authors

Affiliations

¹ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada. Electronic address: Dmitry.Rozenberg@uhn.ca.
² Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
³ Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, BC, Canada.
⁴ KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Psychology, University of Toronto, Toronto, ON, Canada.
⁵ School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; Department of Medicine, Respirology, Nova Scotia Health Authority, Halifax, NS, Canada.
⁶ Department of Physiological Sciences, University of Florida, Gainesville, FL.
⁷ Lung Health Foundation, Toronto, ON, Canada.
⁸ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, ON, Canada; Respirology, University Health Network, Toronto, ON, Canada.
⁹ Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada; Division of Respiratory Medicine, The University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada.
¹⁰ Department of Psychiatry, Krembil Brain Institute, University of Toronto, Toronto, ON, Canada; Neuropsychology Clinic, University Health Network, Toronto, ON, Canada.
¹¹ Temerty Faculty of Medicine, Respirology, University of Toronto, Toronto, ON, Canada; Department of Respiratory Medicine, Westpark Healthcare Centre, Toronto, ON, Canada.
¹² College of Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada.
¹³ School of Physical & Occupational Therapy, McGill University, Montreal, QB, Canada.
¹⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Family Physician Airways Group of Canada, Markham, ON, Canada.
¹⁵ KU Leuven, Faculty of Movement and Rehabilitation Sciences, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium; Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
¹⁶ Division of Respirology, Critical Care and Sleep Medicine, Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada.
¹⁷ Library and Information Services, University Health Network, Toronto, ON, Canada.
¹⁸ Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QB, Canada.
²⁰ Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Rehabilitation Sciences Institute, School of Graduate Studies, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
²¹ Department of Occupational Science & Occupational Therapy, and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada; Rotman Research Institute, Baycrest, Toronto, ON, Canada.
²² Centre for Heart Lung Innovation, Providence Research, The University of British Columbia and St Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.
²³ Department of Research and Development, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
²⁴ Division of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, AB, Canada.
²⁵ Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Supportive Care, University Health Network, Toronto, ON, Canada.

PMID: 38901488
PMCID: PMC11489522
DOI: 10.1016/j.chest.2024.05.027

Abstract

Topic importance: Cognitive and physical limitations are common in individuals with chronic lung diseases, but their interactions with physical function and activities of daily living are not well characterized. Understanding these interactions and potential contributors may provide insights on disability and enable more tailored rehabilitation strategies.

Review findings: This review summarizes a 2-day meeting of patient partners, clinicians, researchers, and lung associations to discuss the interplay between cognitive and physical function in people with chronic lung diseases. This report covers four areas: (1) cognitive-physical limitations in patients with chronic lung diseases; (2) cognitive assessments; (3) strategies to optimize cognition and motor control; and (4) future research directions. Cognitive and physical impairments have multiple effects on quality of life and daily function. Meeting participants acknowledged the need for a standardized cognitive assessment to complement physical assessments in patients with chronic lung diseases. Dyspnea, fatigue, and age were recognized as important contributors to cognition that can affect motor control and daily physical function. Pulmonary rehabilitation was highlighted as a multidisciplinary strategy that may improve respiratory and limb motor control through neuroplasticity and has the potential to improve physical function and quality of life.

Summary: There was consensus that cognitive function and the cognitive interference of dyspnea in people with chronic lung diseases contribute to motor control impairments that can negatively affect daily function, which may be improved with pulmonary rehabilitation. The meeting generated several key research questions related to cognitive-physical interactions in individuals with chronic lung diseases.

Keywords: cognition; exercise; lung disease, interstitial; lung disease, obstructive; rehabilitation.

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Conflict of interest statement

Financial/Nonfinancial Disclosures The authors have reported to CHEST the following: D. R. reports financial support was provided by Canadian Institutes of Health Research, Sandra Faire and Ivan Fecan Professorship in Rehabilitation Medicine and Temerty Faculty of Medicine. W. D. R. reports financial support was provided by Canadian Institutes of Health Research and Canadian Lung Association. A. G. K. reports funding for advisory board or speakers bureau roles for AstraZeneca, Belus, Boehringer Ingelheim, Eisai, GSK, Idorsia, Merck Frosst, Moderna, Novo Nordisk, Pfizer, Respiplus, Sanofi, Teva, Trudel, and Valeo. D. D. M. is an outreach Editor for CHEST. M. A. S. reports grants from Netherlands Lung Foundation, Stichting Astma Bestrijding, Chiesi, AstraZeneca, TEVA, and Boehringer Ingelheim, outside the submitted work; and fees from Boehringer Ingelheim, GSK, and AstraZeneca, outside the submitted work that includes funding grants. M. K. S. is on the COPD Editorial Board for CHEST. None declared (P. C., J. L. C., G. D., P. W. D., H. E., J. H. F., J. A. G., D. Gold, R. S. G., D. Goodridge, T. J.-F., D. L., B. M., A. O.-C., J. O.-A., V. P., P. R., S. R., C. R., M. B. S., J. T., K. W.).

Figures

**Figure 1**
Conceptual model of cognitive and motor control interactions affecting activities of daily living in people with chronic lung disease. Motor and cognitive skills can be considered as a hierarchy. Motor planning requires the selective integration of sensory neural input. Many activities of daily living require very complex cognition and motor control. The ability to perform activities of daily living may be improved through motor learning training strategies. This requires attention, motivation, and comprehension to learn a skilled task and then repetitive practice until the movement or complex action can be performed automatically. Factors such as dyspnea, fatigue, and pain may interfere with the ability to practice or move in a particular manner. Comorbidities can interfere with the desired motor action, whereas cognitive impairment could interfere with comprehension and retention. Conceptual diagram of motor learning pyramid and cognitive interplay adapted from Williams and Shellenberger and Cleutjens et al.

See this image and copyright information in PMC

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[1] Adeloye D., Song P., Zhu Y., et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10:447–458. - PMC - PubMed

[2] Adeloye D., Song P., Zhu Y., et al. Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022;10:447–458. - PMC - PubMed

[3] Wijsenbeek M., Suzuki A., Maher T.M. Interstitial lung diseases. Lancet. 2022;400:769–786. - PubMed

[4] Wijsenbeek M., Suzuki A., Maher T.M. Interstitial lung diseases. Lancet. 2022;400:769–786. - PubMed

[5] Yin H.L., Yin S.Q., Lin Q.Y., et al. Prevalence of comorbidities in chronic obstructive pulmonary disease patients: a meta-analysis. Medicine (Baltimore) 2017;96 - PMC - PubMed

[6] Yin H.L., Yin S.Q., Lin Q.Y., et al. Prevalence of comorbidities in chronic obstructive pulmonary disease patients: a meta-analysis. Medicine (Baltimore) 2017;96 - PMC - PubMed

[7] Higbee D.H., Dodd J.W. Cognitive impairment in COPD: an often overlooked co-morbidity. Expert Rev Respir Med. 2021;15:9–11. - PubMed

[8] Higbee D.H., Dodd J.W. Cognitive impairment in COPD: an often overlooked co-morbidity. Expert Rev Respir Med. 2021;15:9–11. - PubMed

[9] Chang S.S., Chen S., McAvay G.J., et al. Effect of coexisting chronic obstructive pulmonary disease and cognitive impairment on health outcomes in older adults. J Am Geriatr Soc. 2012;60:1839–1846. - PMC - PubMed

[10] Chang S.S., Chen S., McAvay G.J., et al. Effect of coexisting chronic obstructive pulmonary disease and cognitive impairment on health outcomes in older adults. J Am Geriatr Soc. 2012;60:1839–1846. - PMC - PubMed

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Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

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Translating the Interplay of Cognition and Physical Performance in COPD and Interstitial Lung Disease: Meeting Report and Literature Review

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