Assessment of medication management capacity in a predominantly African American and Caribbean American sample of adults with intractable epilepsy

Margolis, Seth A.; Gonzalez, Jeffrey S.; Spindell, J; Mohamadpour, Maliheh; Grant, Arthur C.; Nakhutina, Luba

doi:10.1016/j.yebeh.2018.09.022

Cited by 12 publications

(8 citation statements)

References 48 publications

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“…Consistent with prior literature, those who required assistance with medication management performed more poorly in all cognitive domains and on the MMAA (Fraser et al, 2012;Maddigan et al, 2003;Margolis et al, 2018Margolis et al, , 2021Patterson et al, 2002;Stilley et al, 2010;Sumida et al, 2019). Although we hypothesized that both executive functioning and memory would independently predict functional status in our sample, our findings revealed that only executive functioning provided unique predictive ability above and beyond other cognitive domains.…”

Section: Discussionsupporting

confidence: 85%

“…THE COMPLEMENTARY UTILITY OF COGNITIVE TESTING 3 MMAA MMAA (Patterson et al, 2002) is a standardized medication management role-play task that systematic reviews (Elliott & Marriott, 2009;Farris & Phillips, 2008) have identified as an ecologically valid task deserving of further study. The MMAA has strong test-retest reliability (intraclass correlation coefficient = 0.96; Patterson et al, 2002) and internal consistency (Kuder-Richardson 20 = 0.81 and 0.88, respectively; Margolis et al, 2018Margolis et al, , 2021, as well as concordance with pharmacy refills, pill counts, self-rated medication adherence, and electronically monitored medication taking behavior (Margolis et al, 2018;Patterson et al, 2002;Pratt et al, 2006). In addition to demonstrated clinical validity in individuals with persistent mental illness (Patterson et al, 2002;Pratt et al, 2006), Huntington's disease (Sumida et al, 2018), Parkinson's disease (Pirogovsky et al, 2014), amnestic MCI (Sumida et al, 2019), and epilepsy (Margolis et al, 2018), our group recently found that the MMAA distinguishes older adults with and without dementia at a sensitivity of 0.78 and a specificity of 0.83 (Margolis et al, 2021).…”

Section: Neurocognitive Functioningmentioning

confidence: 99%

“…Indeed, Chaytor and Schmitter-Edgecombe’s (2003) systematic review on ecological validity in neuropsychology reported that tasks high in verisimilitude tend to have stronger and more consistent veridicality than traditional cognitive testing. The Medication Management Ability Assessment (MMAA; Patterson et al, 2002) is an ecologically valid performance-based test that shows particular promise in gauging functional deficits across clinical populations (Margolis et al, 2018; Patterson et al, 2002; Pirogovsky et al, 2014; Pratt et al, 2006; Sumida et al, 2018). The MMAA is high in both verisimilitude and veridicality, as it is simultaneously face-valid and has shown clinical and criterion validity across multiple clinical populations by several research groups including concordance with pharmacy refills, pill counts, and self-rated adherence (Patterson et al, 2002; Pratt et al, 2006), electronically monitored medication taking behavior (Margolis et al, 2018), and diagnostic utility in dementia evaluations (Margolis et al, 2021).…”

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confidence: 99%

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The complementary utility of cognitive testing and the medication management ability assessment in older adults.

Hallowell¹,

Sullivan²,

Davis³

et al. 2022

Neuropsychology

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Objective: Older adults are susceptible to cognitive declines that may limit independence. Though neuropsychologists opine about risk of functional decline, the degree to which cognitive testing and in-office simulations approximate everyday behavior is unclear. We assessed the complementary utility of cognitive testing and the face-valid Medication Management Ability Assessment (MMAA) to predict medication management among older adults. Method: This was a retrospective study of 234 older adults (age = 72 ± 7.7 years; 59% women) who completed the MMAA during outpatient neuropsychological evaluations. Based on comprehensive clinical assessment, most participants (n = 186) were independent in medication management, while 48 received assistance. Demographically adjusted composite scores were derived for attention/processing speed (A/PS), executive functioning (EF), visuospatial/constructional ability (VC), language, and memory domains. Univariate differences in cognition were examined across Assisted versus Independent groups. Logistic regression assessed which cognitive domains independently predicted group status. The incremental value of the MMAA was assessed, holding uniquely associated cognitive test scores constant. Results: Those receiving assistance with medication management performed worse across all neurocognitive domains and the MMAA compared with independent counterparts. EF was the only unique cognitive predictor of medication management status. When modeled alone, EF and MMAA performance correctly classified 79.5% and 80.8% of cases, respectively. When modeled together, both were independently associated with medication management status and correctly classified 83.3% of cases. Conclusions: EF uniquely predicted medication management status beyond other cognitive domains. The MMAA provided complementary predictive utility. Concurrent interpretation of executive functioning and MMAA performance is advised when assessing older adults suspected of medication mismanagement.

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Section: Discussionsupporting

confidence: 85%

Section: Neurocognitive Functioningmentioning

confidence: 99%

mentioning

confidence: 99%

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The complementary utility of cognitive testing and the medication management ability assessment in older adults.

Hallowell¹,

Sullivan²,

Davis³

et al. 2022

Neuropsychology

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“…No qualitative studies were identified. Of these 12 studies, four were conducted in New York [13][14][15][16], two in Massachusetts [17,18] , and one each in Florida [19], Texas [20],…”

Section: Resultsmentioning

confidence: 99%

Social determinants of health associated with epilepsy treatment adherence in the United States: A scoping review

Gaudecker

Buelow

Miller

et al. 2021

Epilepsy & Behavior

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“…A scoping review of epilepsyrelated deaths in the United States of America from 2005 to 2014 revealed that Black/African-American patients had a death rate from the disease of 1.42 out of 100,000, compared to 0.86 per 100,000 for Caucasians and 0.70 per 100,000 for Latinx patients [17]. Black/African-American people with epilepsy are consistently undertreated in the categories of length of time to formal diagnosis, medication management, and the offering of surgical intervention for refractory epilepsy [18]. We advocate for further studies to investigate this question and hopefully improve quality of care for all patients suffering from epilepsy, especially for Black/African-American patients, who have historically been undertreated.…”

Section: Discussionmentioning

confidence: 99%

An Observational Study of an Epilepsy Monitoring Unit in a Level 4 Epilepsy Center, Post-Implementation of the National Association of Epilepsy Centers 2010 Revised Guidelines

et al. 2021

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Background: Of the 2.7 -3.4 million Americans estimated to have some form of epilepsy, approximately 25-30% of these individuals do not have adequate seizure control and suffer from intractable epilepsy. The objective of this study was to report outcomes of patients with epilepsy monitoring unit (EMU) admissions using data from a level 4 epilepsy center. Methods:We performed a retrospective review of electronic medical records for 433 EMU patient visits between January 2016 and May 2019 at a level 4 comprehensive epilepsy center. The EMU protocols followed in these admissions were those listed in the guidelines by the National Association of Epilepsy Centers (NAEC). Patients were monitored by a medical team that included electroencephalogram technicians, neurophysiologists, and epileptologists.Results: Of the 433 patients assessed, 384 met inclusion criteria. Mean length of stay in the EMU was 4 days. Of the patients, 73.4% had EMU stays resulting in new information which led to interventions including further diagnostic testing, surgical treatment, and medication changes. The most frequent intervention was a change in medication (68.8% of patients). Of the patients, 90.1% received a definitive diagnosis at the conclusion of their admission, with the most common diagnosis being epileptic seizures (66.7%), followed by non-epileptic physiologic events (14.3%) and psychogenic nonepileptic seizures (8.6%). Conclusions:This study sought to describe outcomes from patients who stayed in our level 4 epilepsy center's EMU after the implementation of the revised NAEC guidelines made in 2010. We investigated patient demographics as well as diagnosis and/or treatment changes after the EMU stay. We conclude that under the new NAEC guidelines, an EMU admission remains diagnostically useful in identifying if a patient has epilepsy or not. Our goal for this retrospective review is to inform future prospective outcomes studies and add to the body of literature demonstrating an EMU evaluation as a valuable diagnostic tool for epilepsy patients.

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Assessment of medication management capacity in a predominantly African American and Caribbean American sample of adults with intractable epilepsy

Cited by 12 publications

References 48 publications

The complementary utility of cognitive testing and the medication management ability assessment in older adults.

The complementary utility of cognitive testing and the medication management ability assessment in older adults.

Social determinants of health associated with epilepsy treatment adherence in the United States: A scoping review

An Observational Study of an Epilepsy Monitoring Unit in a Level 4 Epilepsy Center, Post-Implementation of the National Association of Epilepsy Centers 2010 Revised Guidelines

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