Executive Function and Medical Non-Adherence: A Different Perspective

Abstract

Medical non-adherence is multifactorial: cost, convenience, side effect profile, and cognitive impairment are all implicated in medical nonadherence. We explore impaired executive function (EF) as a cause for medical non-adherence when other causes can be ruled out. EF describes the coordination and manipulation of higher-order cognitive processes involved in problem-solving, planning, and decision-making. EF has three components: working memory, mental flexibility, and inhibitory control. The latter, inhibitory control, when impaired will affect an individual's ability to make choices to produce long-term benefits, in favor of short-term gratification. When applied to adults with chronic diseases, like diabetes, that require lifestyle modification and, at times, complicated medical regimens to forestall long term complications, an intact EF has a role in adherence. EF development is protracted with behavioral corollaries observable from early childhood. Thus, teachers, family physicians, and pediatricians will be the professionals to first encounter and manage such individuals. We suggest screening tests for children in the doctor's office to detect impaired EF, and postulate a cognitive behavioral therapeutic approach for adults with uncontrolled DM and impaired EF.

Executive Functioning in Children, Adolescents, and Young Adults with Chronic Kidney Disease

“…Several studies have reported significant relationships wherein impaired executive functions were found to be correlated with poorer quality of life, 9,43 less adaptive coping strategies, 9 poor social interactions, 44 academic difficulties, 37,39 and of particular interest for a CKD population, poor medical adherence. [28][29][30][31] The latter problems can result in increased health complications, worse health outcomes, and higher medical costs. 31 Adhering to the complex medical regimens often necessitated by CKD requires goal oriented behaviors, such as taking medications as prescribed, coordinating multiple doctors' appointments, and implementing lifestyle changes (e.g., dietary restrictions), all of which require planning, organization, and inhibitory control for prioritizing long-term health benefits over short-term gratification.…”

“…In particular, for the individual with CKD, poor executive functioning can contribute to difficulty in keeping doctors' appointments, following dietary recommendations, and remembering to take medications. [28][29][30][31] This nonadherence not only increases the risk of medical complications and hospitalizations for the child, adolescent, or young adult with CKD but also has the potential to increase the financial burden to patients, their families, insurance companies, and public assistance programs. 31 However, the directionality of this relationship remains unknown.…”

Brain in Congenital Heart Disease Across the Lifespan

“…It is likely that executive dysfunction impairs the ability of patients to adhere to medical recommendations and follow-up. 54 …”

Neuropsychological dysfunction in adults with early-onset obsessive-compulsive disorder: the search for a cognitive endophenotype

“…[3][4][5][6][7] The primary neuropsychological impairment in OCD lies in executive functions such as working memory, cognitive flexibility, and response inhibition. 5,8,9 These deficits have been hypothesized to mediate the relationship between brain dysfunction and clinical symptomatology in patients with OCD. 10 This observation is supported by studies which show a direct relationship between anterior cingulate (ACC) activity and cognitive control, since the conflict-monitoring processes in the ACC appear to be involved in the engagement of this cognitive ability.…”