***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND patients with dementia are almost invariably unable to use any form of inhaler . Some elderly patients are unable to learn to use a metered dose inhaler or Turbohaler despite a normal abbreviated mental test score . Studies have shown that in many people this is due to unrecognised cognitive impairment and /or dyspraxia . The executive domains of cognition are particularly important in planning and sequencing ; it might be expected therefore that disordered frontal ( executive ) function could be a predictor of poor inhaler technique in subjects with no overt features of dementia . OBJECTIVE to explore the relationship between cognitive , and executive , function and the ability to acquire metered dose inhaler and Turbohaler technique in old age . DESIGN a prospect i ve r and omised observational study with blinded evaluation . SUBJECTS 30 inhaler-naive in patients ( 21 female ) with a mean age of 85 ( range 75 - 94 ) and having a normal ( 8 - 10 ) abbreviated mental test score . METHODS subjects received st and ardised metered dose inhaler and Turbohaler training and were scored on an analogue scale ( for metered dose inhaler ) or for competence ( Turbohaler ) the following day . The Mini-Mental State Examination and EXIT25 ( for executive function ) were performed by separate observers . RESULTS significant correlation was found between the metered dose inhaler score and Mini-Mental State Examination ( r 0.540 , P<0.002 ) and EXIT25 ( r -0.702 , P<0.0001 ) . Threshold effects emerged for the metered dose inhaler in that 18/19 with a competent score compared to 2/11 scored as incompetent had a Mini-Mental State Examination of > 23 ( P<0.01 ) and 19/19 compared to 0/11 had an EXIT25 of < 15 ( P<0.01 ) . Similarly , for the Turbohaler 21/21 of the competent subjects had a Mini-Mental State Examination of > 23 compared with 3/9 incompetent subjects ( P<0.01 ) , with 21/21 competent compared with 0/9 incompetent having an EXIT25 < 15 ( P<0.01 ) . CONCLUSION acquisition and short-term retention of metered dose inhaler and Turbohaler techniques is unlikely to be successful in frail elderly people who have an abnormal Mini-Mental State Examination and /or EXIT25 test . The latter test , when abnormal , is probably the superior predictor of inability to learn inhaler techniques Systemic inflammation is present in chronic obstructive pulmonary disease ( COPD ) , which has been linked to cardiovascular morbidity and mortality . We determined the effects of oral and inhaled corticosteroids on serum markers of inflammation in patients with stable COPD . We recruited 41 patients with mild to moderate COPD . After 4 weeks during which inhaled corticosteroids were discontinued , patients were assigned to fluticasone ( 500 mcg twice a day ) , oral prednisone ( 30 mg/day ) , or placebo over 2 weeks , followed by 8 weeks of fluticasone at 500 mcg twice a day and another 8 weeks at 1,000 mcg twice a day . Withdrawal of inhaled corticosteroids increased baseline C-reactive protein ( CRP ) levels by 71 % ( 95 % confidence interval [ CI ] , 16 - 152 % ) . Two weeks with inhaled fluticasone reduced CRP levels by 50 % ( 95 % CI , 9 - 73 % ) ; prednisone reduced it by 63 % ( 95 % CI , 29 - 81 % ) . No significant changes were observed with the placebo . An additional 8 weeks of fluticasone were associated with CRP levels that were lower than those at baseline ( a 29 % reduction ; 95 % CI , 7 - 46 % ) . Inhaled and oral corticosteroids are effective in reducing serum CRP levels in patients with COPD and suggest their potential use for improving cardiovascular outcomes in COPD The Nocturnal Oxygen Therapy Trial ( NOTT ) showed previously that patients with hypoxemic chronic obstructive pulmonary disease ( COPD ) frequently suffered from neuropsychologic deficit and experienced disturbed mood , personality , and life quality . The present study has followed up 150 NOTT patients six months after they were r and omized to continuous oxygen treatment ( COT ) or nocturnal oxygen treatment ( NOT ) . Tested off oxygen , 42 % showed modest neuropsychologic improvement after six months of therapy , and the rates for COT and NOT were comparable . A sub sample ( n = 37 ) was examined a third time , after 12 months of treatment . At this point patients receiving COT registered better neuropsychologic performance than those receiving NOT . Concurrently , the COT group began showing improved survival . Despite mild neuropsychologic improvement , patients reported little change in emotional status or life quality . It is concluded that prolonged oxygen treatment is associated with small but definite improvement in brain functioning among patients with hypoxemic COPD , and that COT might have some advantage over NOT in enhancing neuropsychologic functioning as well as survival BACKGROUND  Cognitive impairment  frequently occurs in elderly COPD patients , but little is known about its prognostic implication s. We aim ed at evaluating the prognostic role of cognitive impairment in patients with severe COPD . METHODS Our series consisted of 149 stable patients ( mean [ + /- SD ] age , 68.7 + /- 8.5 years ) with COPD and a Pao(2 ) of < 57 mm Hg at rest ( n = 97 ) or at the end of the 6-min walking test ( n = 37 ) who were enrolled in a prospect i ve observational study . After a multidimensional baseline assessment , patients were followed up by telephone calls for a mean duration of 32.5 + /- 9.2 months ( minimal follow-up duration , 24 months ) ; 134 patients were successfully tracked . We used multivariable Cox proportional hazard analysis to identify predictors of death among clinical /functional variables that previously were shown to have prognostic implication s and among neuropsychological indexes selected on the basis of univariate analysis . RESULTS We observed 29 deaths over a median follow-up time of 32 months . Only the two following variables were independently associated with the outcome : an abnormal score on the copy with l and mark test ( hazard ratio [ HR ] , 2.93 ; 95 % confidence interval [ CI ] , 1.34 to 6.39 ) ; and a 6-min walk distance of < 300 m ( HR , 3.46 ; 95 % CI , 1.15 to 10.5 ) . A Pao(2 ) of < 57 mm Hg at rest ( HR , 2.19 ; 95 % CI , 0.93 to 5.18 ) and an FEV(1 ) of < 40 % predicted ( HR , 2.74 ; 95 % CI , 0.99 to 7.57 ) were nearly significantly associated with the outcome , while Paco(2 ) , body mass index , physical dependence , comorbid diseases , and the impairment of cognitive domains other than drawing impairment were unrelated to the outcome . CONCLUSIONS Drawing impairment is a risk factor for mortality and might improve the assessment of hypoxemic COPD patients The objective of the study was to evaluate the effect of multidisciplinary pulmonary rehabilitation program on cognitive function in COPD patients , adjusting for potential confounders ( gender , age , tobacco consumption , and educational level ) . In this prospect i ve study , 34 COPD patients were su bmi tted to neuropsychological testing before and after a 3-month pulmonary rehabilitation program . A control group with 18 healthy subjects of similar age , sex , and educational status was used to compare the cognitive function of COPD patients and healthy subjects at baseline . The association between the rehabilitation and change on th scores of cognitive variables , adjusted for each covariate , was estimated by means of linear r and om-intercept regression models . At baseline , the COPD patients had worse cognitive function with regard to verbal learning , memory , subjective organization , and verbal processing in comparison to the healthy volunteers . The improvement in cognitive performance by the COPD patients was evidence d even after adjusting for the sociodemographic factors that could potentially interfere on cognitive function . Male gender and age less than 65 years old were associated to higher scores in verbal learning and memory at baseline and after the rehabilitation program . The clinical approach to COPD -induced cognitive dysfunction should include participation in pulmonary rehabilitation programs . There were gender- and age-related differences in cognitive scores that persisted after rehabilitation 
    Output:
    
The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment .
The most widely studied cognitive domains are memory and attention .
Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD .
We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities .
The articles review ed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD .