Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke

Abstract

BackgroundWhile medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke.MethodsA systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary measure of effect. Risk of bias was assessed using the Cochrane Bias Methods Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality assessed according to the GRADE approach. We conducted sensitivity analyses according to measure of cognitive impairment, measure of medication adherence, population, risk of bias and adjustment for covariates. The protocol was registered with PROSPERO.ResultsFrom 1,760 titles and abstracts, we identified 9 studies for inclusion. Measures of cognitive impairment varied from dementia diagnosis to standardised cognitive assessments. Medication adherence was assessed through self-report or administrative databases. The majority of studies were of medium risk of bias (n = 6); two studies had low risk of bias. Findings were mixed; when all studies were pooled, there was no evidence of an association between cognitive impairment and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)]. However, heterogeneity was substantial [I2 = 90.9%, p < .001], and the overall evidence quality was low.ConclusionsFew studies have explored associations between cognitive impairment and medication adherence post-stroke, with substantial heterogeneity in study populations, and definitions and assessments of non-adherence and cognitive impairment. Further research using clear, standardised and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke.

What Predicts Different Kinds of Nonadherent Behavior in Elderly People With Parkinson's Disease?

“…The association between cognition and adherence is complex and not yet fully understood (27). While some studies found that cognitive impairment is, in general, a major predictor of nonadherence (28,29), a recent metaanalysis found no association between cognitive impairment and medication nonadherence in post-stroke patients (23). The Adheson study showed that in relation to the Morisky-Green test, patients with cognitive deterioration were 2.1 times more likely to take the treatment incorrectly (13).…”

Secondary Stroke Prevention After Ischemic Stroke in Patients with Alzheimer’s Disease and Other Dementia Disorders

“…Evidence for the association between cognitive impairment and non-adherence is inconsistent. In one pooled analysis, there was no evidence of an association between cognitive impairment and non-adherence [5]. It may, however, be important to distinguish between degrees of cognitive impairment, as individuals with more severe impairments and dementia may rely on caregivers to administer medication, leading to increased adherence.…”

“…Although advances in carotid revascularization have contributed to the improvement in patient outcomes, the absolute effect on population level compared to a pharmacological secondary prevention is small [3]. Treatment of all major risk factors is estimated to reduce the risk of recurrent stroke by about 80% compared with no treatment [1,3] and optimum control of risk factors through the regular use of cardiovascular medication also reduces risk of cognitive impairment and cardiovascular events [5,6].…”

“…Much of the research on secondary prevention has been performed in younger and healthier subjects, while the burden of stroke is highest in the oldest subset of the population [8]. Older age and cognitive impairment may hinder the institution of secondary prevention due to increased susceptibility to adverse drug events in older adults, ethical issues concerning prevention in patients with limited life expectancies [8], or the assumption that cognitively impaired patients have decreased adherence to drug regimens [5].…”

Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia

“…This finding supports the conclusions from other studies that diabetes predisposes to cognitive decline both in humans and animal models [12,[30][31][32][33], and this finding also holds true for our study cohort who had TB and dysglycaemia. Cognitive decline may negatively affect compliance to the strict requirements of TB treatment including adherence to medications which can potentially worsen disease outcomes [34].…”