Examination of the Cognitive and Emotional Sequelae Effecting Medication Adherence in MS
Bridging science and practice
Individuals with MS exhibit deficits in cognitive and emotional functioning. These deficits may contribute to poor medication adherence to disease modifying therapy (DMT). The goal of this pilot study was to examine the rates of adherence and to explore factors affecting adherence to treatment protocols in a MS sample.
Objective: Most disease-modifying therapies (DMTs) for multiple sclerosis (MS) are self-injectable medications that must be taken on an ongoing basis (Devonshire et al., 2011). DMTs have been shown to reduce exacerbations, formation of brain lesions, and disease progression (Goodmin, 2008). However, when compared to other patient populations, patients with MS may be at increased risk for poor long-term adherence (Bruce, Hancock, Arnett & Lynch, 2010). Cognitive and emotional sequelae are prevalent in individuals with MS (Arnett, 2003) and are associated with poor medication adherence (Bruce et al., 2010). Given the paucity of research evaluating adherence patterns in MS, the goal of this pilot study was to examine the rates of adherence and to explore factors affecting adherence among patients with clinically definite MS.
Participants: Twelve individuals with relapse-remitting, secondary-progressive, or progressive-relapsing MS participated in the study. MS participants were predominately female (91.6%). The sample was majority Caucasian (66.6%) with a small number of African-Americans (16.6%) and Hispanics (8.3%). The mean age was 46.5 ± 11.60 years with 14.6 ± 1.93 years of education. Duration since diagnosis was 12.9 ± 9.17 years and time since first symptom was 16.1 ± 9.51 years.
Procedure: Participants, aged 18 to 65, were recruited through clinics at UMDNJ, the Northern New Jersey MS Society, and the Kessler Institute for Rehabilitation. Participants were only included in the study if they were free of a history of prior neurological insult, significant psychiatric history, alcohol and drug history, and were right-handed. Participants completed a neuropsychological test battery, which included a self-report measure of medication adherence.
Results: The preliminary findings of this pilot study revealed that 75% of the participants (n = 9) exhibited poor adherence. The most common reasons for non-adherence were forgetting to take medications. Of those non-adherent, 44% missed taking medications at least 1-2 times during the last week and 56% missed taking medications >2 days over the past 3 months. Adherence was highly correlated with executive function, as measured by the Brixton Spatial Anticipation Test, r = .759, p = .049, but did not correlate with measures of learning and memory, processing speed, attention, fatigue, or depression. Although the correlation was not significant with adherence, performance on measures of learning and memory and depression demonstrated trend toward significance. This suggests that these values may become significant with increased sample size.
Conclusions: Individuals with MS have difficulty with adhering to prescribed medications. Self-reported adherence was highly correlated with executive function, indicating that organization and the ability to follow rules may be necessary to adhering to medication regimens. As pilot data continues, we anticipate that these trends in other areas of cognition (i.e. learning and memory) and depression will become significantly related to adherence. An increased understanding of the cognitive and emotional factors that contribute to medication adherence in MS will be important in designing rehabilitation interventions to optimize adherence, and thereby treatment efficacy and overall quality of life.