Title: Cerebral oxygen availability during exercise in COPD patients with cognitive impairment
Online Data Supplement Vasileios Andrianopoulos1, Ioannis Vogiatzis2,3, Rainer Gloeckl1,4, Robert Bals5, Rembert A. Koczulla1,6,7, Klaus Kenn1,6,7 Affiliations 1
Department of Respiratory Medicine & Exercise Therapy; Schoen Klinik Berchtesgadener Land;
Schoenau am Koenigssee, Germany 2Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, United Kingdom 3Faculty of Physical Education and Sports Sciences, National and Kapodistrian University of Athens, Greece 4Department for Prevention and Sports Medicine, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany 5Department of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany 6Department of Pulmonary Rehabilitation, Philipps University Marburg, Marburg, Germany 7German Center of Lung Research (DZL), Giessen-Marburg, Germany
Corresponding author information Vasileios Andrianopoulos, PhD Department of Respiratory Medicine & Exercise Therapy; Schoen Klinik Berchtesgadener Land; Schoenau am Koenigssee, Germany. Tel: +49 (0)8652 93-1524 Email:
[email protected] Respir Physiol Neurobiol. 2018 May 2;254:64-72
Supplementary tables S1. Incidence of evidence indicating cognitive impairment for CI patients CI patients
S-MMSE ≤26
ACE-R ≤86
TICS ≤32
MoCA ≤25
Evidence(s), n
1
X
X
X
X
4
X
X
X
3
X
3
X
1
X
3
X
1
2 3
X
X
4 5
X
X
6 7
X
X
X
X
4
8
X
X
X
3
9
X
X
X
3
X
1
X
2
X
3
X
1
10 11
X
12
X
X
13 14
X
X
X
X
4
15
X
X
X
X
4
16
X
X
2
17
X
X
2
X
1
18 19
X
X
X
X
4
20
X
X
X
X
4
X
2
21
X
Incidents of evidence for cognitive impairment in COPD patients stratified as cognitively impaired (CI). In sixteen (n=16) out of twenty-one patients (76%), cognitive impairment according to MoCA (Nasreddine et al., 2005) evaluation was additionally confirmed in one or more of the other cognitive assessment tests including the S-MMSE (Molloy et al., 1991), ACE-R (Mioshi et al., 2006), and TICS (Brandt et al., 1988). 2
S2. Correlation matrix amongst haemoglobin indices and cognitive evaluation outcomes Oxy-Hb
Deoxy-Hb
Total-Hb
S-MMSE
ACE-R
MoCA
T-ICS
RT, post exercise
Acc., post exercise
Oxy-Hb
1
.143
.493**
.341*
.315*
.278
.190
-.164
.090
Deoxy-Hb
.143
1
.421**
.040
-.183
.009
-.073
-.081
-.192
Total-Hb
.493**
.421**
1
-.003
-.033
.099
-.065
-.007
-.211
S-MMSE
.341*
.040
-.003
1
.829**
.736**
.704**
-.198
.463**
ACE-R
.315*
-.183
-.033
.829**
1
.771**
.784**
-.311*
.546**
MoCA
.278
.009
.099
.736**
.771**
1
.801**
-.373**
.573**
T-ICS
.190
-0.73
-0.65
.704**
.784**
.801**
1
-.283*
.522**
RT, post exercise
-.164
-.081
-.007
-.198
-.311*
-.373**
-.283*
1
-.385**
Acc., post exercise
.090
-.192
-.211
.463**
.546**
.573**
.522**
-.385**
1
Pearson correlation amongst changes [Δ] in cerebral haemoglobin (-Hb) indices at the limit of exercise tolerance and cognitive function performance as assessed by several cognitive tests including the Stroop Test (RT: cognitive Reaction Time, Acc.: Accuracy [tested immediately after cycle endurance exercise test]). Asterisks denote significance with p < 0.05 (*) and p< 0.001 (**).
3
Supplemental Materials for Methods Stroop test (ST) Colour-Word Stroop with Keyboard Responding; application software by Milliseconds Cognitive function was assessed for both speed and accuracy using the stroop color word test (Jensen and Rohwer, 1966; Stroop, 1935). The stroop test requires subjects to name the ink-colour of a colour word and it is used to investigate aspects of cognitive performance (cognitive reaction time and accuracy) that depend on executive functioning. Specifically, it is a good clinical tool for providing information on patients’ selective attention to specific information and the inhibition of prepotent response during decision‐making tasks involving stimuli and responses (MacLeod, 1991).
In the stroop test, the colour word is either the same (congruent) or not the same (incongruent) as the ink colour. In the electronic version of the stroop test which was used in current study, also bars of colours (no words) were appearing in the screen (control) controlling for the ability of patients to recognize the colours. Four colours were appearing in the computer screen: Blue, Green, Red, and Black. A translated into German version of the stroop test, where the names of colours appear in German language, was used.
The stroop test was administered on a computer screen using randomized incongruent words and colors‐recognition tests (www.millisecond.com) at patients’ room in noise-free condition to minimize distractions and increase the comfort level. Patients were asked to be concentrated and produce fast and accurate responds naming the visual ink-colour of 4 different words of colours which was often 4
incongruous. For example, the words ”blue”, ”green”, ”red”, ”black” often depicted in an ink-colour which did not match with the name of the colour – “i.e. the word «blue» appearing in red colour”. Patients had to ignore the meaning of the word appearing in the screen and indicate only the depicted colour of the word. The trial of stroop test included eighty-four (n=84) items which were congruent, incongruent, or control as previously described. Previously, a color‐labeled keyboard was prepared (Four keybord-keys had colour-stickers on them; blue-, green-, red-, black- sticker, respectively; Picture 1).
Before the beginning of the test, patients familiarized with the procedure in order to ensure that they completely understood their task. Only since the task was clear for the patients, the test was administered. At the end of test, the mean time of patients’ responses was calculated by the computer and reported as milliseconds. In the current study, the stroop test response time presented as seconds and estimated from the mean time of all responses (mean congruent + incongruent + control time divided by 3). Moreover, the false responses were recorded for the estimation of the percentage of the correct answers (i.e a total of 4 false responses to 84 items resulted in 95.2% of correct answers). The stroop test outcomes were the average of the reaction time (in seconds) and the number of correct responds (in percentage of 84 items) to assess the speed and accuracy, respectively at rest and at immediately at the end of exercise.
5
Picture 1.
Estimation of peak work rate (WRpeak) To determine the workload in cycle endurance test (CET), we used the regression equation of Luxton and colleagues (Luxton et al., 2008) which allows the estimation of cycling WRpeak from the sixminute walk distance (6MWD) in COPD patients.
Regression Equation: Work Rate peak (watts) = 103.217 + (30.500 x Gender
Women=0; Men=1)
+ (-1.613 x Age) + (0.002 x
(6MWDm x Weight kg)
R2= 0.80, P
