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Health Beliefs and Medication Adherence in Black Patients with Diabetes and Mild Cognitive Impairment.

ABSTRACT: OBJECTIVES:To evaluate determinants of medication adherence and glycemic control in black patients with diabetes and mild cognitive impairment (MCI). METHODS:Cross-sectional study of 143 participants with mean age of 68.8 (SD: 6.7) years; 66.4% were women. RESULTS:Eighty-seven participants (60.8%) self-reported medication nonadherence; they had more negative beliefs about medicines, greater diabetes-related distress, and more difficulty with daily living activities and affording medications than adherent participants. There were no group differences in cognition, depressive symptoms, or glycemic control. Glycemic control negatively correlated with regimen distress, emotional burden, interpersonal distress, beliefs that physicians overprescribe medications, and beliefs that medications are harmful. CONCLUSIONS:Beliefs about medications, diabetes-related distress, functional disability, and medication affordability are associated with medication nonadherence in black individuals with diabetes and MCI. Interventions that respect personal health beliefs and compensate for impaired cognition may improve medication adherence and glycemic control in this population.

SUBMITTER: Rovner BW

PROVIDER: S-EPMC6008206 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Health Beliefs and Medication Adherence in Black Patients with Diabetes and Mild Cognitive Impairment.

Rovner Barry W BW Casten Robin J RJ

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20180323 7

<h4>Objectives</h4>To evaluate determinants of medication adherence and glycemic control in black patients with diabetes and mild cognitive impairment (MCI).<h4>Methods</h4>Cross-sectional study of 143 participants with mean age of 68.8 (SD: 6.7) years; 66.4% were women.<h4>Results</h4>Eighty-seven participants (60.8%) self-reported medication nonadherence; they had more negative beliefs about medicines, greater diabetes-related distress, and more difficulty with daily living activities and affo ...[more]

PMID: 29673896

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Project description:In addition to clinical comorbidities, psychological and neuropsychological problems are frequent in COPD and may affect pulmonary rehabilitation delivery and outcome. The aims of the study were to describe a COPD population in a rehabilitative setting as regards the patients depressive symptoms, anxiety, mild cognitive impairment (MCI) and self-reported adherence and to analyze their relationships; to compare the COPD sample MCI scores with normative data; and to investigate which factors might predict adherence to prescribed physical exercise. This was a multicenter observational cross-sectional study. Of the 117 eligible stable COPD inpatients, 84 were enrolled according to Global initiative for chronic Obstructive Lung Disease (GOLD) criteria (mainly in Stage III-IV). The assessment included Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), anxiety, depression and self-reported pharmacological and nonpharmacological adherence. From the MMSE, 3.6% of patients were found to be impaired, whereas from the MoCA 9.5% had a likely MCI. Patients referred had mild-severe depression (46.7%), anxiety (40.5%), good pharmacological adherence (80.3%) and difficulties in following prescribed diet (24.1%) and exercise (51.8%); they struggled with disease acceptance (30.9%) and disease limitations acceptance (28.6%). Most of them received good family (89%) or social (53%) support. Nonpharmacological adherence, depression, anxiety and MCI showed significant relations with 6-minute walking test, body mass index (BMI) and GOLD. Depression was related to autonomous long-term oxygen therapy modifications, disease perception, family support and MCI. In the multivariate logistic regression analysis, higher BMI, higher depression and lower anxiety predicted lower adherence to exercise prescriptions (P=0.0004, odds ratio =0.796, 95% CI =0.701, 0.903; P=0.009, odds ratio =0.356, 95% CI =0.165, 0.770; and P=0.05, odds ratio =2.361, 95% CI =0.995, 5.627 respectively). In COPD patients, focusing on pharmacological and nonpharmacological adherence enhance the possibility of tailored pulmonary rehabilitation programs.

Project description:ImportanceMild cognitive impairment (MCI) is a transition state between normal cognitive aging and dementia that increases the risk for progressive cognitive decline. Preventing cognitive decline is a public health priority.ObjectiveTo determine whether behavioral activation prevents cognitive and functional decline over 2 years in black individuals with MCI.Design, setting, and participantsSingle-center, single-masked, attention-controlled randomized clinical trial. Participants were enrolled from June 21, 2011, to October 3, 2014, and follow-up ended December 13, 2016. Community-based recruitment and treatment of black individuals older than 65 years with amnestic MCI. Volunteer sample of 1390 persons with memory complaints were screened. Overall, 536 individuals had baseline assessment, and 315 (58.8%) were ineligible, most often owing to normal cognition (205 of 315 [65%]) or dementia (59 of 315 [18.7%]); 221 fully eligible participants were randomized. Analyses were intention to treat.InterventionsParticipants were randomized to behavioral activation, which aimed to increase cognitive, physical, and social activity (111 [50.2%]), or supportive therapy, an attention control treatment (110 [49.8%]).Main outcomes and measuresThe prespecified primary outcome was a decline of 6 or more recalled words on the total recall score of the Hopkins Verbal Learning Test-Revised assessed at 6, 12, 18, and 24 months. The secondary outcome was functional decline.ResultsOf 221 randomized participants (mean [SD] age, 75.8 [7.0] years, 175 women [79%]), 77 behavioral activation participants (69.4%) and 87 supportive therapy participants (79.1%) had 2-year outcome assessments. After baseline, behavioral activation participants engaged in significantly more cognitive activities than supportive therapy participants. The 2-year incidence of memory decline was 1.2% (95% CI, 0.2-6.4) for behavioral activation vs 9.3% (95% CI, 5.30-16.4) for supportive therapy (relative risk, 0.12; 95% CI, 0.02-0.74; P = .02). Behavioral activation was associated with stable everyday function, whereas supportive therapy was associated with decline (difference in slopes, 2.71; 95% CI, 0.12-5.30; P = .04). Rates of serious adverse events for behavioral activation and supportive therapy, respectively, were: falls (14 [13%] vs 28 [25%]), emergency department visits (24 [22%] vs 24 [22%]), hospitalizations (36 [32%] vs 31 [28%]), and deaths (7 [5%] vs 3 [4%]).Conclusions and relevanceBehavioral activation prevented cognitive and functional decline, but this finding requires further investigation. Black individuals have almost twice the rate of dementia as white individuals; behavioral activation may reduce this health disparity.Trial registrationClinicalTrials.gov Identifier: NCT01299766.

Project description: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.

Project description:BackgroundThis study assesses the feasibility of using machine learning methods such as Random Forests (RF), Artificial Neural Networks (ANN), Support Vector Regression (SVR) and Self-Organizing Feature Maps (SOM) to identify and determine factors associated with hypertensive patients' adherence levels. Hypertension is the medical term for systolic and diastolic blood pressure higher than 140/90 mmHg. A conventional medication adherence scale was used to identify patients' adherence to their prescribed medication. Using machine learning applications to predict precise numeric adherence scores in hypertensive patients has not yet been reported in the literature.MethodsData from 160 hypertensive patients from a tertiary hospital in Kuala Lumpur, Malaysia, were used in this study. Variables were ranked based on their significance to adherence levels using the RF variable importance method. The backward elimination method was then performed using RF to obtain the variables significantly associated with the patients' adherence levels. RF, SVR and ANN models were developed to predict adherence using the identified significant variables. Visualizations of the relationships between hypertensive patients' adherence levels and variables were generated using SOM.ResultMachine learning models constructed using the selected variables reported RMSE values of 1.42 for ANN, 1.53 for RF, and 1.55 for SVR. The accuracy of the dichotomised scores, calculated based on a percentage of correctly identified adherence values, was used as an additional model performance measure, resulting in accuracies of 65% (ANN), 78% (RF) and 79% (SVR), respectively. The Wilcoxon signed ranked test reported that there was no significant difference between the predictions of the machine learning models and the actual scores. The significant variables identified from the RF variable importance method were educational level, marital status, General Overuse, monthly income, and Specific Concern.ConclusionThis study suggests an effective alternative to conventional methods in identifying the key variables to understand hypertensive patients' adherence levels. This can be used as a tool to educate patients on the importance of medication in managing hypertension.

Project description:BACKGROUND/OBJECTIVES:Behavioral problems in individuals with Alzheimer's disease (AD) impose major management challenges. Current prevention strategies are anchored to cognitive outcomes, but behavioral outcomes may provide another, clinically relevant opportunity for preemptive therapy. We sought to determine whether personality changes that predispose to behavioral disorders arise during the transition from preclinical AD to mild cognitive impairment (MCI). DESIGN:Longitudinal observational cohort study. SETTING:Academic medical center. PARTICIPANTS:Members of an apolipoprotein E (APOE) ?4 genetically enriched cohort of Maricopa County residents who were neuropsychiatrically healthy at entry (N = 277). Over a mean interval of 7 years, 25 who developed MCI and had the Neuroticism, Extraversion, and Openness Personality Inventory-Revised (NEO-PI-R) before and during the MCI transition epoch were compared with 252 nontransitioners also with serial NEO-PI-R administrations. INTERVENTION:Longitudinal administration of the NEO-PI-R and neuropsychological test battery. MEASUREMENTS:Change in NEO-PI-R factor scores (neuroticism, extraversion, openness, agreeableness, conscientiousness) from entry to the epoch of MCI diagnosis or an equivalent follow-up duration in nontransitioners. RESULTS:NEO-PI-R neuroticism T-scores increased significantly more in MCI transitioners than in nontransitioners (mean 2.9, 95% confidence interval (CI) = 0.9-4.9 vs 0, 95% CI = -0.7-0.7, P = .02), and openness decreased more in MCI transitioners than in nontransitioners (-4.8, 95% CI = -7.3 to -2.4 vs -1.0, 95% CI = -1.6 to -0.4, P < .001). Concurrent subclinical but statistically significant changes in behavioral scores worsened more in MCI transitioners than nontransitioners for measures of depression, somatization, irritability, anxiety, and aggressive attitude. CONCLUSION:Personality and subclinical behavioral changes begin during the transition from preclinical AD to incident MCI and qualitatively resemble the clinically manifest behavioral disorders that subsequently arise in individuals with frank dementia.

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Health Beliefs and Medication Adherence in Black Patients with Diabetes and Mild Cognitive Impairment.

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Health Beliefs and Medication Adherence in Black Patients with Diabetes and Mild Cognitive Impairment.

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