ACMJ

Anatolian Current Medical Journal (ACMJ) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

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Original Article
Neurocognitive correlates of functional impairment in COPD: the roles of sluggish cognitive tempo and cognitive flexibility
Aims: The present study aims to examine differences in cognitive flexibility and sluggish cognitive tempo (SCT) levels in individuals diagnosed with Chronic obstructive pulmonary disease (COPD) according to disease stage and to evaluate the independent and indirect relationships of these cognitive processes on daily functioning. Methods: The cross-sectional study included 162 COPD patients classified according to GOLD 2024 criteria (GOLD A=46, GOLD B=55, GOLD E=61). Participants were administered the SCT Scale, Cognitive Flexibility Inventory (CFI), Hospital Anxiety and Depression Scale (HADS), COPD Assessment Test (CAT), and Functional Assessment Short Scale (FAST). Variables predicting daily functioning and SCT were examined using hierarchical regression analyses; mediating relationships were assessed using the PROCESS macro. Results: SCT levels were significantly higher in advanced COPD groups (p=0.015). In hierarchical regression, SCT was the strongest predictor of daily functioning (ß=0.35, p


1. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2025
2. Karnati S, Seimetz M, Kleefeldt F, et al. Chronic obstructive pulmonary disease and the cardiovascular system: vascular repair and regeneration as a therapeutic target. Front Cardiovasc Med. 2021;8:649512. doi:10. 3389/fcvm.2021.649512
3. Yu X, Xiao H, Liu Y, Dong Z, Meng X, Wang F. The lung-brain axis in chronic obstructive pulmonary disease-associated neurocognitive dysfunction: mechanistic insights and potential therapeutic options. Int J Biol Sci. 2025;21(8):3461-3477. doi:10.7150/ijbs.109261
4. Rahi MS, Thilagar B, Balaji S, et al. The Impact of Anxiety and Depression in Chronic Obstructive Pulmonary Disease. Adv Respir Med. 2023;91(2):123-134. doi:10.3390/arm91020011
5. Günaydın S, Şimşek MH, Şimşek ŞM. The effect of clinical and psychosocial factors on quality of life in COPD: a cross-sectional assessment using a mediation analysis approach. Front Psychiatry. 2026; 17:1756291. doi:10.3389/fpsyt.2026.1756291
6. Samajdar S, Halder S, Mahato AK. Attention, memory, and executive functioning in hypoxemic chronic obstructive pulmonary disease patients. Ann of Indian Psychiatry. 2022;6(3):233-237. doi:10.4103/aip.aip_85_21
7. Pokharel P, Khanal S, Ghimire R, et al. Cognitive Impairment Among Chronic Obstructive Pulmonary Disease Patients of Nepal: A Cross-Sectional Study. Health Sci Rep. 2025;8(10):e71315. doi:10.1002/hsr2.71315
8. Baird C, Lovell J, Johnson M, Shiell K, Ibrahim JE. The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: a systematic review. Respir Med. 2017;129:130-139. doi:10.1016/j.rmed.2017.06.006
9. Becker SP, Barkley RA. Sluggish Cognitive Tempo. Oxford textbook of attention deficit hyperactivity disorder. 2018;13:147-153
10. Pasten JG, Aguayo JC, Aburto J, et al. Dual-task performance in individuals with chronic obstructive pulmonary disease: a systematic review with meta-analysis. Pulm Med. 2024;2024(1):1230287. doi:10. 1155/2024/1230287
11. Cleutjens FA, Franssen FM, Spruit MA, et al. Domain-specific cognitive impairment in patients with COPD and control subjects. Int J Chron Obstruct Pulmon Dis. 2016;12:1-11. doi:10.2147/COPD.S119633
12. Pande B, Sinha M, Sinha R, et al. Cognitive correlates of circadian rhythm and sleep-wake behaviour in chronic obstructive pulmonary disease patients. Chronobiol Int. 2024;41(10):1313-1327. doi:10.1080/07420528. 2024.2410242
13. Moradi F, Askarizadeh G, Bagheri M. Information processing speed, visuospatial working memory and cognitive failures in middle-aged and older adults with chronic obstructive pulmonary disease. 2024;19(1):84-99. doi:10.32598/sija.2023.3711.1
14. Gosling CJ, Cartigny A, Scoriels L, Portalier C, Laidi C, Mallet J. La flexibilité cognitive: une dimension cognitive clé. Med Sci (Paris). 2025; 41(5):443-450. doi:10.1051/medsci/2025075
15. Brunette AM, Warner K, Holm KE, et al. Daily activities: the ımpact of COPD and cognitive dysfunction. Arch Clin Neuropsychol. 2021;36(5): acaa090-767. doi:10.1093/arclin/acaa090
16. Altan-Atalay A, Fatih Boluvat M. Cognitive flexibility and depression: the moderator roles of humor styles. Curr Psychol. 2024;43(23):20814-20823. doi:10.1007/s12144-024-05931-8
17. Fritz MS, MacKinnon DP. Required sample size to detect the mediated effect. Psychol Sci. 2007;18(3):233-239. doi:10.1111/j.1467-9280.2007. 01882.x
18. Gul A, Gul H. Psychometric validation of Barkley's Adult Sluggish Cognitive Tempo (SCT) Ratings Scale-Turkish version and distinguishing SCT from attention deficit-hyperactivity disorder (ADHD) among Turkish adults. Res Dev Disabil. 2022;121:104155. doi: 10.1016/j.ridd.2021.104155
19. Barkley RA. Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. J Abnorm Psychol. 2012; 121(4):978-990. doi:10.1037/a0023961
20. Sapmaz F, Doğan T. Assessment of cognitive flexibility: reliability and validity studies of Turkish version of the Cognitive Flexibility Inventory. Ankara Univ J Fac Educ Sci. 2013;46(1):143-162.s doi:10.1501/Egifak_0000001278
21. Dennis JP, Vander Wal JS. The Cognitive Flexibility Inventory: instrument development and estimates of reliability and validity. Cogn Ther Res. 2010;34(3):241-253. doi:10.1007/s10608-009-9276-4
22. Aydemir O. Hastane anksiyete ve depresyon olcegi Turkce formunun gecerlilik ve guvenilirligi. Turk Psikiyatri Derg. 1997;8:187-280.
23. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
24. Aydemir O, Uykur B. Reliability and validity study of the Turkish version of functioning assessment short test in bipolar disorder. Turk Psikiyatri Derg. 2012;23(3):193-200.
25. Rosa AR, Sánchez-Moreno J, Martínez-Aran A, et al. Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clin Pract Epidemiol Ment Health. 2007;3(1):5. doi:10.1186/ 1745-0179-3-5
26. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. 3rd ed. The Guilford Press. 2022.
27. Mackinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behav Res. 2004;39(1):99. doi:10.1207/s15327906mbr3901_4
28. Torres-Sánchez I, Rodríguez-Alzueta E, Cabrera-Martos I, López-Torres I, Moreno-Ramírez MP, Valenza MC. Cognitive impairment in COPD: a systematic review. J Bras Pneumol. 2015;41(2):182-190. doi:10.1590/S1806-37132015000004424
29. Weiss JR, Serdenes R, Madtha U, et al. Association among chronic obstructive pulmonary disease severity, exacerbation risk, and anxiety and depression symptoms in the SPIROMICS cohort. J Acad Consult Liaison Psychiatry. 2023;64(1):45-57. doi:10.1016/j.jaclp.2022.07.008
30. Wu D, Zhao X, Huang D, et al. Outcomes associated with comorbid anxiety and depression among patients with stable COPD: a patient registry study in China. J Affect Disord. 2022;313:77-83. doi:10.1016/ j.jad.2022.06.059
31. Fei F, J Siegert R, Zhang X, Gao W, Koffman J. Symptom clusters, associated factors and health-related quality of life in patients with chronic obstructive pulmonary disease: a structural equation modelling analysis. J Clin Nurs. 2023;32(1-2):298-310. doi:10.1111/jocn.16234
32. Gong B, Shang S, Wu C. Association between cognitive declines and disability in activities of daily living in older adults with COPD: evidence from the China health and retirement longitudinal study. BMJ Open. 2020;10(10):e040098. doi:10.1136/bmjopen-2020-040098
33. MacPherson HA, Kudinova AY, Schettini E, et al. Relationship between cognitive flexibility and subsequent course of mood symptoms and suicidal ideation in young adults with childhood-onset bipolar disorder. Eur Child Adolesc Psychiatry. 2022;31(2):299-312. doi:10.1007/s00787-020-01688-0
34. Rassam P, Pazzianotto-Forti EM, Matsumura U, et al. Impact of cognitive capacity on physical performance in chronic obstructive pulmonary disease patients: a scoping review. Chron Respir Dis. 2023;20: 14799731231163874. doi:10.1177/14799731231163874
35. Siraj RA. Comorbid cognitive impairment in chronic obstructive pulmonary disease (COPD): current understanding, risk factors, implications for clinical practice, and suggested interventions. Medicina (Kaunas). 2023;59(4):732. doi:10.3390/medicina59040732
Volume 8, Issue 3, 2026
Page : 401-408
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