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Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke

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  • Daniela Rohde
  • Niamh A Merriman
  • Frank Doyle
  • Kathleen Bennett
  • David Williams
  • Anne Hickey

Abstract

Background: While 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. Methods: A 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. Results: From 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

Suggested Citation

  • Daniela Rohde & Niamh A Merriman & Frank Doyle & Kathleen Bennett & David Williams & Anne Hickey, 2017. "Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke," PLOS ONE, Public Library of Science, vol. 12(12), pages 1-19, December.
    • Handle: RePEc:plo:pone00:0189339
    DOI: 10.1371/journal.pone.0189339
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    References listed on IDEAS

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    1. Jonathan A.C. Sterne & Roger M. Harbord, 2004. "Funnel plots in meta-analysis," Stata Journal, StataCorp LP, vol. 4(2), pages 127-141, June.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Hyun-Joo Seong & Kyounghoon Lee & Bo-Hwan Kim & Youn-Jung Son, 2019. "Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation," IJERPH, MDPI, vol. 16(15), pages 1-11, July.

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