Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort.
Aged
Aged, 80 and over
Antihypertensive Agents
/ therapeutic use
Caregivers
/ psychology
Cognitive Dysfunction
/ complications
Cohort Studies
Female
Fibrinolytic Agents
/ therapeutic use
Follow-Up Studies
Humans
Hypolipidemic Agents
/ therapeutic use
Male
Medication Adherence
/ statistics & numerical data
Middle Aged
Neuropsychological Tests
Prevalence
Secondary Prevention
Severity of Illness Index
Stroke
/ complications
Stroke Rehabilitation
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
01
06
2019
accepted:
02
10
2019
entrez:
18
10
2019
pubmed:
18
10
2019
medline:
18
3
2020
Statut:
epublish
Résumé
Control of vascular risk factors is essential for secondary stroke prevention. However, adherence to secondary prevention medications is often suboptimal, and may be affected by cognitive impairment. Few studies to date have examined associations between cognitive impairment and medication adherence post-stroke, and none have considered whether adherence to secondary prevention medications might affect subsequent cognitive function. The aim of this study was to explore prospective associations between cognitive impairment and medication non-adherence post-stroke. A five-year follow-up of 108 stroke survivors from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective observational cohort study. Cognitive function was assessed using the Montreal Cognitive Assessment at 6 months, and a neuropsychological test battery at 5 years. Adherence to antihypertensive, antithrombotic and lipid-lowering medications was assessed using prescription refill data. The prevalence of cognitive impairment at five years was 35.6%. The prevalence of non-adherence ranged from 15.1% for lipid-lowering agents to 30.2% for antithrombotics. There were no statistically significant associations between medication non-adherence in the first year post-stroke and cognitive impairment at 5 years, nor between cognitive impairment at 6 months and non-adherence at 5 years. Stroke survivors with cognitive impairment were significantly more likely to report receiving help with taking medications [OR (95% CI): 4.84 (1.17, 20.07)]. This is the first study to explore the potential impact of non-adherence to secondary prevention medications on cognitive impairment in stroke survivors. Findings highlight the role of family members and caregivers in assisting stroke survivors with medication administration, particularly in the context of deficits in cognitive function. Involving family members and caregivers may be a legitimate and cost-effective strategy to improve medication adherence in stroke survivors.
Sections du résumé
BACKGROUND
Control of vascular risk factors is essential for secondary stroke prevention. However, adherence to secondary prevention medications is often suboptimal, and may be affected by cognitive impairment. Few studies to date have examined associations between cognitive impairment and medication adherence post-stroke, and none have considered whether adherence to secondary prevention medications might affect subsequent cognitive function. The aim of this study was to explore prospective associations between cognitive impairment and medication non-adherence post-stroke.
METHODS
A five-year follow-up of 108 stroke survivors from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective observational cohort study. Cognitive function was assessed using the Montreal Cognitive Assessment at 6 months, and a neuropsychological test battery at 5 years. Adherence to antihypertensive, antithrombotic and lipid-lowering medications was assessed using prescription refill data.
RESULTS
The prevalence of cognitive impairment at five years was 35.6%. The prevalence of non-adherence ranged from 15.1% for lipid-lowering agents to 30.2% for antithrombotics. There were no statistically significant associations between medication non-adherence in the first year post-stroke and cognitive impairment at 5 years, nor between cognitive impairment at 6 months and non-adherence at 5 years. Stroke survivors with cognitive impairment were significantly more likely to report receiving help with taking medications [OR (95% CI): 4.84 (1.17, 20.07)].
CONCLUSIONS
This is the first study to explore the potential impact of non-adherence to secondary prevention medications on cognitive impairment in stroke survivors. Findings highlight the role of family members and caregivers in assisting stroke survivors with medication administration, particularly in the context of deficits in cognitive function. Involving family members and caregivers may be a legitimate and cost-effective strategy to improve medication adherence in stroke survivors.
Identifiants
pubmed: 31622438
doi: 10.1371/journal.pone.0223997
pii: PONE-D-19-15566
pmc: PMC6797135
doi:
Substances chimiques
Antihypertensive Agents
0
Fibrinolytic Agents
0
Hypolipidemic Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0223997Déclaration de conflit d'intérêts
DW has served in the past as an advisory board member for Boehringer Ingelheim, Daiichi Sankyo, Bristol Myers Squibb, and Bayer, and has received personal fees for this outside the submitted work. DW received a speaker honorarium for Boehringer Ingelheim and has received personal fees for this outside the submitted work. All other authors report no conflicting interests. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
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