Neuropsychological functioning, age, and medication adherence in bipolar disorder

Objectives Poor adherence to medication is frequent in bipolar disorder (BD) and has been associated with several factors. To date, the relationship between low adherence and neuropsychological functioning in BD is still unclear. As age and neuropsychological functioning might have opposing influences on adherence, our aim was to investigate this link with a particular focus on the effect of age. Methods In a cross-sectional study, we included 353 patients divided into two age-groups (16–46; 47–71) from a French cohort diagnosed with BD (type I, II, NOS) and strictly euthymic. All patients had a standardized clinical and neuropsychological assessment and were categorized as high (n = 186) or low (n = 167) adherent based on their score from the Medication Adherence Rating Scale. Clinical information was collected based on a standardized interview and clinical validated scales. Neuropsychological performances were evaluated with an established standardized neuropsychological battery for bipolar disorder patients. After univariate analysis, neuropsychological and clinical predictors of low adherence were included in two age-specific stepwise multiple logistic regressions. Results A smaller number of hospitalizations (OR = 0.846, p = 0.012), a shorter illness duration (OR = 0.937, p = 0.003) and higher adverse effects (OR = 1.082, p<0.001) were associated with a greater risk of low adherence in the younger patients. In the older patients, low adherence was also predicted by a smaller number of hospitalizations (OR = 0.727, p = 0.008) and higher adverse effects (OR = 1.124, p = 0.005). Interestingly poor inhibition performance was also a significant predictor of low adherence in older patients (OR = 0.924, p = 0.030). Conclusions We found an age-specific relationship between cognitive functioning and adherence in patients with BD. Poor inhibition performances predicted low adherence in older patients only. Our results highlight the need to provide age-adapted therapeutic interventions to improve adherence in patients with BD.

[1]  A. Nierenberg,et al.  Clinical features associated with poor pharmacologic adherence in bipolar disorder: results from the STEP-BD study. , 2010, The Journal of clinical psychiatry.

[2]  M. Valenstein,et al.  Age comparison of treatment adherence with antipsychotic medications among individuals with bipolar disorder , 2007, International journal of geriatric psychiatry.

[3]  M. Leboyer,et al.  Depressive residual symptoms are associated with lower adherence to medication in bipolar patients without substance use disorder: results from the FACE-BD cohort. , 2013 .

[4]  D. Dickinson,et al.  Meta‐analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables , 2011, Bipolar disorders.

[5]  F. Johnson,et al.  Factors That Affect Adherence to Bipolar Disorder Treatments: A Stated-Preference Approach , 2007, Medical care.

[6]  S. Koch,et al.  Ability of Older People with Dementia or Cognitive Impairment to Manage Medicine Regimens: A Narrative Review , 2015, Current clinical pharmacology.

[7]  Jodie B. Ullman,et al.  Aging, neurocognition, and medication adherence in HIV infection. , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[8]  E. Broadbent,et al.  Intentional and unintentional treatment nonadherence in patients with systemic lupus erythematosus , 2011, Arthritis care & research.

[9]  S. Frangou,et al.  Fronto-temporal function may distinguish bipolar disorder from schizophrenia. , 2006, Bipolar disorders.

[10]  M. Rabie,et al.  Cognitive functions among euthymic bipolar I patients after a single manic episode versus recurrent episodes. , 2011, Journal of affective disorders.

[11]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[12]  Jan Scott,et al.  Treatment non‐adherence in affective disorders , 2002, Acta psychiatrica Scandinavica.

[13]  F. Kapczinski,et al.  Correlation between drug treatment adherence and lithium treatment attitudes and knowledge by bipolar patients , 2007, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[14]  R. Porter,et al.  The neurocognitive profile of mood disorders – a review of the evidence and methodological issues , 2015, Bipolar disorders.

[15]  D Ongur,et al.  Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder , 2010, Psychological Medicine.

[16]  Charles D. Spielberger,et al.  State-Trait Anxiety Inventory for Adults , 2012 .

[17]  M. Fava,et al.  The impact of diabetes on depression treatment outcomes. , 2010, General hospital psychiatry.

[18]  R. C. Young,et al.  A Rating Scale for Mania: Reliability, Validity and Sensitivity , 1978, British Journal of Psychiatry.

[19]  O. Selnes.  A Compendium of Neuropsychological Tests , 1991, Neurology.

[20]  C B Mayhorn,et al.  Effect of age on event-based and time-based prospective memory. , 1997, Psychology and aging.

[21]  W. Tang,et al.  Prospective memory deficits in patients with bipolar disorder: a preliminary study. , 2010, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[22]  M. McInnis,et al.  The double burden of age and disease on cognition and quality of life in bipolar disorder , 2014, International journal of geriatric psychiatry.

[23]  G. Dunn,et al.  A large-scale validation study of the Medication Adherence Rating Scale (MARS) , 2008, Schizophrenia Research.

[24]  J. J. Ryan,et al.  Scoring Reliability on the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) , 2003, Assessment.

[25]  O. Andreassen,et al.  Predictors of medication adherence in patients with schizophrenia and bipolar disorder , 2012, Acta psychiatrica Scandinavica.

[26]  S. Woods,et al.  The role of prospective memory in medication adherence: a review of an emerging literature , 2011, Journal of Behavioral Medicine.

[27]  D. Glahn,et al.  The International Society for Bipolar Disorders-Battery for Assessment of Neurocognition (ISBD-BANC). , 2010, Bipolar disorders.

[28]  S. Crowe,et al.  The differential contribution of mental tracking, cognitive flexibility, visual search, and motor speed to performance on parts A and B of the Trail Making Test. , 1998, Journal of clinical psychology.

[29]  M. Leboyer,et al.  Treatment nonadherence and neurocognitive impairment in bipolar disorder. , 2009, The Journal of clinical psychiatry.

[30]  D. Wechsler,et al.  Wechsler Adult Intelligence Scale—Fourth Edition (WAIS-IV) , 2010 .

[31]  Abigail L. Wroe,et al.  Intentional and Unintentional Nonadherence: A Study of Decision Making , 2002, Journal of Behavioral Medicine.

[32]  Daniel Weintraub,et al.  Medication Management and Neuropsychological Performance in Parkinson's Disease , 2012, The Clinical neuropsychologist.

[33]  Roger Mundry,et al.  Stepwise Model Fitting and Statistical Inference: Turning Noise into Signal Pollution , 2008, The American Naturalist.

[34]  M. Schölvinck,et al.  Differential components of prospective memory? Evidence from fMRI , 2006, Neuropsychologia.

[35]  F. Dickerson,et al.  Prospective memory deficits in euthymic bipolar disorder patients: A preliminary study , 2013, Asia-Pacific psychiatry : official journal of the Pacific Rim College of Psychiatrists.

[36]  E. Vieta,et al.  Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients , 2016, Journal of clinical psychopharmacology.

[37]  J. Ospina-Duque,et al.  Effects of recurrence on the cognitive performance of patients with bipolar I disorder: implications for relapse prevention and treatment adherence. , 2010, Bipolar disorders.

[38]  C. Harada,et al.  Normal cognitive aging. , 2013, Clinics in geriatric medicine.

[39]  A. Sergejew,et al.  Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses , 2000, Schizophrenia Research.

[40]  David A. Loewenstein,et al.  An Evaluation of the NINCDS-ADRDA Neuropsychological Criteria for the Assessment of Alzheimers Disease: A Confirmatory Factor Analysis of Single Versus Multi-Factor Models , 2001, Journal of clinical and experimental neuropsychology.

[41]  P. Areán,et al.  Adherence to antidepressant medications in black and Latino elderly patients. , 2005, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[42]  M. Åsberg,et al.  A New Depression Scale Designed to be Sensitive to Change , 1979, British Journal of Psychiatry.

[43]  B. Neville,et al.  Neuro-cognitive impairment following acquired central nervous system infections in childhood: a systematic review , 2003, Brain Research Reviews.

[44]  J. Haro,et al.  Clinical and economic consequences of medication non-adherence in the treatment of patients with a manic/mixed episode of bipolar disorder: Results from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM) Study , 2011, Psychiatry Research.

[45]  S. Jang,et al.  Predictors of adherence to medication in older Korean patients with hypertension , 2013, European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology.

[46]  C. Hinkin,et al.  Increased neurocognitive intra-individual variability is associated with declines in medication adherence in HIV-infected adults. , 2015, Neuropsychology.

[47]  John R. Crawford,et al.  The Executive Decline Hypothesis of Cognitive Aging: Do Executive Deficits Qualify as Differential Deficits and Do They Mediate Age-Related Memory Decline? , 2000 .

[48]  K. Arbuthnott,et al.  Trail Making Test, Part B as a Measure of Executive Control: Validation Using a Set-Switching Paradigm , 2000, Journal of clinical and experimental neuropsychology.

[49]  M. McDaniel,et al.  Normal aging and prospective memory. , 1990, Journal of experimental psychology. Learning, memory, and cognition.

[50]  M. First,et al.  Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research version (SCID-I RV) , 2002 .

[51]  M. Kliegel,et al.  Clinical neuropsychology of prospective memory , 2008 .

[52]  C. McHorney,et al.  Unintentional non-adherence to chronic prescription medications: How unintentional is it really? , 2012, BMC Health Services Research.

[53]  T. Carmody,et al.  The effect of cognitive functioning on treatment attendance and adherence in comorbid bipolar disorder and cocaine dependence. , 2015, Journal of substance abuse treatment.

[54]  T. Wykes,et al.  Patients' perspectives on electroconvulsive therapy: systematic review , 2003, BMJ : British Medical Journal.

[55]  A. Godbolt,et al.  Systematic review of the risk of dementia and chronic cognitive impairment after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. , 2014, Archives of physical medicine and rehabilitation.

[56]  Y. Joanette,et al.  [Formal and semantic lexical evocation in normal subjects. Performance and dynamics of production as a function of sex, age and educational level]. , 1990, Acta neurologica Belgica.

[57]  C. Lançon,et al.  Neurocognition, Insight and Medication Nonadherence in Schizophrenia: A Structural Equation Modeling Approach , 2012, PloS one.

[58]  E. Brietzke,et al.  Determinants of adherence to treatment in bipolar disorder: a comprehensive review. , 2013, Journal of affective disorders.

[59]  R. Tabarés-Seisdedos,et al.  Long-term outcome of cognitive impairment in bipolar disorder. , 2012, The Journal of clinical psychiatry.

[60]  M. Sajatovic,et al.  Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review , 2016, CNS Drugs.

[61]  Philip D. Harvey,et al.  Neuropsychological function and dysfunction in schizophrenia and psychotic affective disorders. , 2009, Schizophrenia bulletin.

[62]  H. Amièva,et al.  Metabolic syndrome and cognitive decline in French elders , 2011, Neurology.

[63]  Alfredo Rizo-Méndez,et al.  Low compliance to pharmacological treatment is linked to cognitive impairment in euthymic phase of bipolar disorder. , 2016, Journal of affective disorders.

[64]  Marion Leboyer,et al.  Tests of executive functions in first-degree relatives of schizophrenic patients: a meta-analysis , 2004, Psychological Medicine.

[65]  E. Paykel.  Manic–Depressive Illness: Bipolar Disorders and Recurrent Depression (2nd edn) , 2008, British Journal of Psychiatry.

[66]  K. Kortte,et al.  The Trail Making Test, Part B: Cognitive Flexibility or Ability to Maintain Set? , 2002, Applied neuropsychology.

[67]  S. Frangou,et al.  Empirical evidence for discrete neurocognitive subgroups in bipolar disorder: clinical implications , 2014, Psychological Medicine.

[68]  C. Golden.  Diagnosis and Rehabilitation in Clinical Neuropsychology , 1981 .

[69]  G. McCarthy,et al.  Intentional and unintentional medication non-adherence: a comprehensive framework for clinical research and practice? A discussion paper. , 2007, International journal of nursing studies.

[70]  J. Calabrese,et al.  The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. , 2009, Bipolar disorders.

[71]  Sophia Frangou,et al.  Stroop performance in bipolar disorder: further evidence for abnormalities in the ventral prefrontal cortex. , 2006, Bipolar disorders.

[72]  E. Holmes,et al.  Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology , 2009, Journal of psychopharmacology.

[73]  W. D’Souza,et al.  Cognitive functioning in idiopathic generalised epilepsies: A systematic review and meta-analysis , 2014, Neuroscience & Biobehavioral Reviews.

[74]  A. Beekman,et al.  Cognitive impairment in late life schizophrenia and bipolar I disorder , 2013, International journal of geriatric psychiatry.

[75]  B. Pennington,et al.  Executive functions and developmental psychopathology. , 1996, Journal of child psychology and psychiatry, and allied disciplines.

[76]  M. Van der Linden,et al.  Age-related differences in supervisory attentional system functions. , 2000, The journals of gerontology. Series B, Psychological sciences and social sciences.

[77]  D. Yurgelun-Todd,et al.  Decreased activation of the anterior cingulate in bipolar patients: an fMRI study. , 2004, Journal of affective disorders.

[78]  M. Leboyer,et al.  A French network of bipolar expert centres: a model to close the gap between evidence-based medicine and routine practice. , 2011, Journal of affective disorders.

[79]  R. Reitan.  Validity of the Trail Making Test as an Indicator of Organic Brain Damage , 1958 .

[80]  I. Bauer,et al.  The Management of Cognitive Impairment in Bipolar Disorder: Current Status and Perspectives , 2015, American journal of therapeutics.