1
|
Alcocer-Bruno C, Ferrer-Cascales R, Ruiz-Robledillo N, Clement-Carbonell V. The mediation effect of treatment fatigue in the association between memory and health-related quality of life in men with HIV who have sex with men. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 38145625 DOI: 10.1080/23279095.2023.2298375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Approximately half of all adults living with the Human Immunodeficiency Virus (HIV) experience cognitive alterations related to difficulties in treatment adherence and, therefore, to a significant decrease in quality of life. In this sense, new studies are needed to identify potential mediators related to treatment in this association, such as treatment fatigue. This fact is especially important in at specific groups of individuals with HIV, namely men with HIV who have sex with men (MSM). The objective of this study was to analyze the association between cognitive functioning, Health-Related Quality of Life (HRQoL), and treatment fatigue in MSM with HIV. A cross-sectional study was developed with a sample of 70 MSM, from the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). Participants completed questionnaires related to sociodemographic data, HRQoL, and treatment fatigue in an initial phase; in a second phase, they were administered a computerized cognitive evaluation. Our results demonstrate a significant relationship between a lower cognitive performance in the memory domain and worse HRQoL. Mediation analysis has revealed the total mediation effect of treatment fatigue, specifically, the treatment cynicism domain, on this relationship. This mediation effect remained significant after controlling the sociodemographic and clinical HIV-related variables in the model. No significant mediation effects of the rest of evaluated cognitive domains (attention, perception, reasoning, or coordination) were found in this relationship. The results of this study highlight how MSM with a significant deterioration of memory are at greater risk of developing high levels of treatment fatigue, and, therefore, a lower adherence to the same and a significant deterioration in their HRQoL.
Collapse
Affiliation(s)
- C Alcocer-Bruno
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - R Ferrer-Cascales
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - N Ruiz-Robledillo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| | - V Clement-Carbonell
- Department of Health Psychology, Faculty of Health Science, University of Alicante, Alicante, Spain
| |
Collapse
|
2
|
Keller C, Ferrer RA, King RB, Collier E. Future directions of the National Institutes of Health Science of Behavior Change Program. Transl Behav Med 2021; 11:1795-1801. [PMID: 33837790 PMCID: PMC8083271 DOI: 10.1093/tbm/ibab029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The National Institutes of Health Science of Behavior Change Common Fund Program has accelerated the investigation of mechanisms of behavior change applicable to multiple health behaviors and outcomes and facilitated the use of the experimental medicine approach to behavior change research. Purpose This commentary provides a brief background of the program, plans for its next phase, and thoughts about how the experimental medicine approach to behavior change research can inform future directions in two areas of science—reproductive health and COVID-19 vaccine uptake. Conclusions The incorporation of a mechanisms-based approach into behavior intervention research offers new opportunities for improving health.
Collapse
Affiliation(s)
| | | | - Rosalind B King
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Elaine Collier
- National Center for Advancing Translational Sciences, Bethesda, Maryland, USA
| |
Collapse
|
3
|
Konstantinopoulou E, Ioannidis P, Kiosseoglou G, Aretouli E. Inhibitory control is associated with medication adherence in young HIV patients without comorbidities. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1467-1475. [PMID: 33631076 DOI: 10.1080/23279095.2021.1890594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In the present study we evaluated the incremental contribution of executive cognition (EC) subprocesses to antiretroviral medication adherence. METHOD A comprehensive EC test battery assessing updating/working memory, mental flexibility, and inhibitory control, along with measures assessing non-executive cognitive functions were completed by 100 individuals with HIV. Medication adherence was determined via a visual analogue self-report scale and the Medication Adherence Questionnaire. Potential predictors, including demographic and clinical characteristics and neuropsychological performances on EC and other cognitive tasks were regressed to medication adherence. Predictive variables related to executive processes were added in the final block of the hierarchical regression model in order to assess their incremental predictive ability on medication adherence. RESULTS 23% of the variance in the visual analogue scale was explained by treatment complexity, memory and EC performance. A measure of inhibitory control, in particular, predicted self-reported medication adherence above and beyond demographic, clinical and other cognitive factors. CONCLUSIONS The contribution of EC to self-reported medication adherence in young seropositive adults was limited, but inhibitory control was associated with proper medication management above and beyond demographic, clinical and other cognitive functions.
Collapse
Affiliation(s)
- Eleni Konstantinopoulou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Grigoris Kiosseoglou
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Aretouli
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,School of the Social Sciences, University of Ioannina, Ioannina, Greece
| |
Collapse
|
4
|
Spies G, Denckla CA, Mall S, Levin J, Seedat S, Nakasujja N, Kinyanda E. The relationship between cognitive change and physical health and behavioural outcomes in a Ugandan cohort of adults living with HIV - a longitudinal study. AIDS Care 2018; 31:803-808. [PMID: 30421989 DOI: 10.1080/09540121.2018.1545987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We investigated changes in cognitive function and physical health and behavioural outcomes (HIV disease progression, health-seeking behaviour, adherence to HIV medications and risky sexual behaviour) at baseline and 12 months later among 1126 Ugandan adults living with HIV. Overall, cognitive function improved from baseline to follow-up, except for gait speed, which was slower at follow-up compared to baseline. There were improvements in physical health and behavioural outcomes by follow-up, with greater improvements among individuals on ART compared to those not on ART. Change in gait speed over time significantly predicted risky sexual behaviours at follow-up. This is the first study to investigate the longitudinal relationships between cognitive function and health outcomes among Ugandan adults living with HIV and provide insights into the possible links between cognitive function and negative clinical and behavioural health outcomes in people living with HIV.
Collapse
Affiliation(s)
- G Spies
- a Department of Psychiatry, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - C A Denckla
- b Department of Epidemiology , Harvard T. H. Chan School of Public Health , Cambridge , MA , USA
| | - S Mall
- c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - J Levin
- c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,d Statistical Section , MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
| | - S Seedat
- a Department of Psychiatry, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - N Nakasujja
- e Department of Psychiatry , Makerere University , Kampala , Uganda
| | - E Kinyanda
- e Department of Psychiatry , Makerere University , Kampala , Uganda.,f Mental Health Project, MRC/LSHTM/UVRI and Senior Wellcome Trust Fellow , Uganda
| |
Collapse
|
5
|
Caballero J, Ownby RL, Jacobs RJ, Thomas JE, Schweizer MS. Association Between Cognitive Tests and Antiretroviral Medication Adherence in Older Adults With HIV. Ann Pharmacother 2018; 53:151-158. [PMID: 30175588 DOI: 10.1177/1060028018798327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND One of the fastest growing populations living with HIV is older adults especially those 65 years of age or older. Current antiretroviral therapy (ART) has prolonged life expectancy of persons with HIV. However, for therapy to be effective, patients need to be adherent. Over time, older persons with HIV may experience HIV-associated neurocognitive disorders or other factors that could affect ART adherence. The use of expedient cognitive tests that help measure medication adherence may be useful for the optimal care of these patients. OBJECTIVE To investigate the association between cognitive tests and ART adherence. METHODS This was a prospective study evaluating patients 65 years of age or older with HIV. Cognitive tests used included the Executive Clock-Drawing Task (CLOX) 1 and 2, Trail Making Test parts A and B, and Grooved Pegboard Test (GPB). The medication event monitoring system cap over 1 month was used as the primary measure for adherence. RESULTS CLOX 1 and GPB were significantly related to adherence ( P < 0.05). Comparison of the magnitude of each measure's relation to adherence suggests that the GPB is a better indicator of ability to adhere ( R = 0.514 vs R = 0.381). Conclusion and Relevance: CLOX 1 and GPB demonstrated an association with adherence in patients 65 years of age or older with HIV. Although the use of these tests to measure adherence in older persons with HIV seems promising, more research is needed to ascertain their ultimate utility.
Collapse
|
6
|
Wang YQ, Pan Y, Zhu S, Wang YG, Shen ZH, Wang K. Selective impairments of alerting and executive control in HIV-infected patients: evidence from attention network test. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2017; 13:11. [PMID: 28651626 PMCID: PMC5485500 DOI: 10.1186/s12993-017-0129-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Attention ability can be subdivided into three functionally independent networks, i.e., alerting network, orienting network, and executive network. Previous literature has documented that deficits in attention are a common consequence of HIV infection. However, the precise nature of deficits of attention in HIV-infected patients is poorly understood. Accordingly, the aim of the study was to identify whether the HIV-infected patients showed a specific attention network deficit or a general attentional impairment. METHODS We investigated 27 HIV-infected patients and 31 normal controls with the Attention Network Test (ANT). RESULTS The patients exhibited less efficient alerting network and executive network than controls. No significant difference was found in orienting network effect between groups. Our results also indicate a tendency for poorer efficiency on alerting attention and executive attention in patients with CD4 ≤ 200. CONCLUSIONS Our findings suggest that HIV-infected patients exhibited selective impairments of attention network of alerting and executive control. The link between lower CD4 T cell count and poorer attention network function imply the importance of starting antiretroviral therapy earlier to avoid irreversible neurocognitive impairment.
Collapse
Affiliation(s)
- Yi-Quan Wang
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, 310013, Zhejiang, China
- Clinical Institute of Mental Health in Hangzhou, Anhui Medical University, Hangzhou, Zhejiang, China
| | - Yang Pan
- School of Media and Design, Hangzhou Dianzi University, Hangzhou, Zhejiang, China
| | - Sheng Zhu
- The Fifth Hospital of Ruian, Ruian, Zhejiang, China
| | - Yong-Guang Wang
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, 310013, Zhejiang, China.
- Clinical Institute of Mental Health in Hangzhou, Anhui Medical University, Hangzhou, Zhejiang, China.
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China.
| | - Zhi-Hua Shen
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, 310013, Zhejiang, China
- Clinical Institute of Mental Health in Hangzhou, Anhui Medical University, Hangzhou, Zhejiang, China
| | - Kai Wang
- Collaborative Innovation Center for Neuropsychiatric Disorders and Mental Health, Hefei, Anhui, China
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
7
|
Fox AT, Martin LE, Bruce J, Moreno JL, Staggs VS, Lee HS, Goggin K, Harris KJ, Richter K, Patten C, Catley D. Executive function fails to predict smoking outcomes in a clinical trial to motivate smokers to quit. Drug Alcohol Depend 2017; 175:227-231. [PMID: 28458075 PMCID: PMC5425305 DOI: 10.1016/j.drugalcdep.2017.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/16/2016] [Accepted: 01/15/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Executive function (EF) is considered an important mediator of health outcomes. It is hypothesized that those with better EF are more likely to succeed in turning their intentions into actual health behaviors. Prior studies indicate EF is associated with smoking cessation. Experimental and longitudinal studies, however, have yielded mixed results. Few studies have examined whether EF predicts post-treatment smoking behavior. Fewer still have done so prospectively in a large trial. We sought to determine if EF predicts quit attempts and cessation among community smokers in a large randomized trial evaluating the efficacy of motivational interventions for encouraging cessation. METHODS Participants (N=255) completed a baseline assessment that included a cognitive battery to assess EF (Oral Trail Making Test B, Stroop, Controlled Oral Word Association Test). Participants were then randomized to 4 sessions of Motivational Interviewing or Health Education or one session of Brief Advice to quit. Quit attempts and cessation were assessed at weeks 12 and 26. RESULTS In regression analyses, none of the EF measures were statistically significant predictors of quit attempts or cessation (all ps>0.20). CONCLUSIONS Our data did not support models of health behavior that emphasize EF as a mediator of health outcomes. Methodological shortcomings weaken the existing support for an association between EF and smoking behavior. We suggest methodological improvements that could help move this potentially important area of research forward.
Collapse
Affiliation(s)
- Andrew T Fox
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | - Laura E Martin
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS 66160, USA; Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jared Bruce
- Department of Psychology, University of Missouri - Kansas City, 5030 Cherry Hall, Room 313, Kansas City, MO, 64110, USA
| | - Jose L Moreno
- Department of Psychiatry, University of Texas Health Science Center - San Antonio,7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA
| | - Vincent S Staggs
- Health Services and Outcomes Research, Children's Mercy Kansas City,2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri - Kansas City,2411 Holmes Street Kansas City, MO 64108, USA
| | - Hyoung S Lee
- Interdisciplinary Arts and Sciences, University of Washington Tacoma, 1900 Commerce St, Tacoma, WA 98402-3100, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City,2401 Gillham Road, Kansas City, MO 64108, USA; School of Medicine, University of Missouri - Kansas City,2411 Holmes Street Kansas City, MO 64108, USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana,Skaggs Building Room 352, Missoula, MT 59812, USA
| | - Kimber Richter
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Christi Patten
- Department of Psychology and Psychiatry, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City,2401 Gillham Rd., Kansas City, MO 64108, USA
| |
Collapse
|
8
|
Fleming KA, Heintzelman SJ, Bartholow BD. Specifying Associations Between Conscientiousness and Executive Functioning: Mental Set Shifting, Not Prepotent Response Inhibition or Working Memory Updating. J Pers 2015; 84:348-60. [PMID: 25564728 DOI: 10.1111/jopy.12163] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Conscientiousness is characterized by self-control, organization, and goal orientation and is positively related to a number of health and professional outcomes. Thus, it is commonly suggested that conscientiousness should be related to superior executive functioning (EF) abilities, especially prepotent response inhibition. However, little empirical support for this notion has emerged, perhaps due to oversimplified and underspecified modeling of EF. The current study sought to fill this gap by testing relations between conscientiousness and three facets of EF using a nested factors latent variable approach. Participants (N = 420; Mage = 22.5; 50% male; 91% Caucasian) completed a measure of conscientiousness and nine EF tasks designed to tap three related yet distinguishable facets of EF: working memory updating, mental set shifting, and prepotent response inhibition. Structural equation models showed that conscientiousness is positively associated with the EF facet of mental set shifting but not response inhibition or working memory updating. Despite the common notion that conscientiousness is associated with cognitive abilities related to rigid control over impulses (i.e., inhibition), the current results suggest the cognitive ability most associated with conscientiousness is characterized by flexibility and the ability to adapt to changing environmental contingencies and task demands.
Collapse
|
9
|
Klepin HD, Geiger AM, Bandos H, Costantino JP, Rapp SR, Sink KM, Lawrence JA, Atkinson HH, Espeland MA. Cognitive factors associated with adherence to oral antiestrogen therapy: results from the cognition in the study of tamoxifen and raloxifene (Co-STAR) study. Cancer Prev Res (Phila) 2013; 7:161-8. [PMID: 24253314 DOI: 10.1158/1940-6207.capr-13-0165] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Little is known about the cognitive factors associated with adherence to antiestrogen therapy. Our objective was to investigate the association between domain-specific cognitive function and adherence among women in a clinical prevention trial of oral antiestrogen therapies. We performed a secondary analysis of Co-STAR, an ancillary study of the STAR breast cancer prevention trial in which postmenopausal women at increased breast cancer risk were randomized to tamoxifen or raloxifene. Co-STAR enrolled nondemented participants ≥65 years old to compare treatment effects on cognition. The cognitive battery assessed global cognitive function (Modified Mini-Mental State Exam), and specific cognitive domains of verbal knowledge, verbal fluency, figural memory, verbal memory, attention and working memory, spatial ability, and fine motor speed. Adherence was defined by a ratio of actual time taking therapy per protocol ≥80% of expected time. Logistic regression was used to evaluate the association between cognitive test scores and adherence to therapy. The mean age of the 1,331 Co-STAR participants was 67.2 ± 4.3 years. Mean 3MS score was 95.1 (4.7) and 14% were nonadherent. In adjusted analyses, the odds of nonadherence were lower for those with better scores on verbal memory [OR (95% confidence interval): 0.75 (0.62-0.92)]. Larger relative deficits in verbal memory compared with verbal fluency were also associated with nonadherence [1.28 (1.08-1.51)]. Among nondemented older women, subtle differences in memory performance were associated with medication adherence. Differential performance across cognitive domains may help identify persons at greater risk for poor adherence.
Collapse
Affiliation(s)
- Heidi D Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, NC 27157.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Relationships among neurocognitive status, medication adherence measured by pharmacy refill records, and virologic suppression in HIV-infected persons. J Acquir Immune Defic Syndr 2013. [PMID: 23202813 DOI: 10.1097/qai.0b013e31827ed678] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal antiretroviral therapy (ART) effectiveness depends on medication adherence, which is a complex behavior with many contributing factors, including neurocognitive function. Pharmacy refill records offer a promising and practical tool to assess adherence. METHODS A substudy of the CHARTER (CNS HIV Anti-Retroviral Therapy Effects Research) study was conducted at the Johns Hopkins University (JHU) and the University of Washington. Pharmacy refill records were the primary method to measure ART adherence, indexed to a "sentinel" drug with the highest central nervous system penetration-effectiveness score. Standardized neuromedical, neuropsychological, psychiatric, and substance use assessments were performed at enrollment and at 6 months. Regression models were used to determine factors associated with adherence and relationships between adherence and changes in plasma and cerebrospinal fluid HIV RNA concentrations between visits. RESULTS Among 80 (33 at JHU and 47 at University of Washington) participants, the mean adherence score was 86.4%, with no difference between sites. In the final multivariable model, better neurocognitive function was associated with better adherence, especially among participants who were at JHU, male, and HIV infected for a longer period of time. Worse performance in working memory tests was associated with worse adherence. Better adherence predicted greater decreases in cerebrospinal fluid HIV RNA between visits. CONCLUSIONS Poorer global neurocognitive functioning and deficits in working memory were associated with lower adherence defined by a pharmacy refill record measure, suggesting that assessments of cognitive function, and working memory in particular, may identify patients at risk for poor ART adherence who would benefit from adherence support.
Collapse
|
11
|
Cairns A, Hill C, Dark F, McPhail S, Gray M. The Large Allen Cognitive Level Screen as an Indicator for Medication Adherence among Adults Accessing Community Mental Health Services. Br J Occup Ther 2013. [DOI: 10.4276/030802213x13627524435180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.
Collapse
Affiliation(s)
- Alice Cairns
- Occupational Therapist, Rehabilitation Clinical Academic Unit, Metro South Mental Health Service, Queensland Health, and PhD Candidate, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Cathy Hill
- Occupational Therapist, Older Persons Clinical Academic Unit, Metro South Mental Health Service, Queensland Health, Queensland, Australia
| | - Frances Dark
- Clinical Director, Rehabilitation and Psychosis Clinical Academic Units, Metro South Mental Health Service, Queensland Health, Queensland, Australia
| | - Steven McPhail
- Senior Research Fellow, School of Public Health and Social Work, Queensland University of Technology and Centre for Functioning and Health Research, Metro South Health Service, Queensland Health, Queensland, Australia
| | - Marion Gray
- Discipline Lead — Occupational Therapy, School of Health and Sport Science, University of the Sunshine Coast, Queensland, Australia
| |
Collapse
|
12
|
Menon CV, Jahn DR, Mauer CB, O'Bryant SE. Executive functioning as a mediator of the relationship between premorbid verbal intelligence and health risk behaviors in a rural-dwelling cohort: a Project FRONTIER study. Arch Clin Neuropsychol 2013; 28:169-79. [PMID: 23192834 PMCID: PMC3569949 DOI: 10.1093/arclin/acs102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 12/23/2022] Open
Abstract
Limited research is available regarding the impact of neuropsychological functioning on health risk behaviors in rural-dwelling elderly populations. This cross-sectional study examined the relationships between estimated premorbid verbal IQ (AMNART), executive functioning impairment (EXIT25), and health risk behaviors including alcohol use (AUDIT), smoking, compliance with recommended cancer screenings, and obesity (BMI). The total sample included 456 English-speaking adults and older adults of non-Hispanic White and Hispanic origin seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Regression analyses revealed significant independent effects of AMNART and EXIT25 on most health risk behaviors, and supported the hypothesized mediating role of EXIT25 on the relationships between AMNART and smoking, cancer screenings, and BMI in both cognitively impaired and healthy subgroups. This study clarifies the relationships between executive functioning, premorbid IQ, and health risk behaviors in diverse groups, and confirms that premorbid IQ represents an important determinant of health behaviors and neurocognitive outcomes.
Collapse
Affiliation(s)
- Chloe V. Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Danielle R. Jahn
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Cortney B. Mauer
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Sid E. O'Bryant
- Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
- Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, TX, USA
| |
Collapse
|
13
|
Bonn-Miller MO, Oser ML, Bucossi MM, Trafton JA. Cannabis use and HIV antiretroviral therapy adherence and HIV-related symptoms. J Behav Med 2012; 37:1-10. [DOI: 10.1007/s10865-012-9458-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/20/2012] [Indexed: 11/28/2022]
|
14
|
Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence. J Behav Med 2010; 34:128-38. [PMID: 20857187 DOI: 10.1007/s10865-010-9293-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 08/25/2010] [Indexed: 10/19/2022]
Abstract
Cocaine abuse among HIV patients is associated with faster disease progression and mortality. This study examined the relationship between neurocognitive functioning and medication adherence in HIV patients with (n = 25) and without (n = 39) current cocaine dependence. Active users had greater neurocognitive impairment (mean T-score = 35.16 vs. 40.97, p < .05) and worse medication adherence (mean z-score = -0.44 vs. 0.27, p < .001). In a multiple regression model, neurocognitive functioning (β = .33, p < .01) and cocaine dependence (β = -.36, p < .01) were predictive of poorer adherence. There was a significant indirect effect of cocaine dependence on medication adherence through neurocognitive impairment (estimate = -0.15, p < .05), suggesting that neurocognitive impairment partially mediated the relationship between cocaine dependence and poorer adherence. These results confirm that cocaine users are at high risk for poor HIV outcomes and underscore the importance of treating both neurocognitive impairment and cocaine dependence among HIV patients.
Collapse
|
15
|
Mo PKH, Mak WWS. Intentionality of medication non-adherence among individuals living with HIV/AIDS in Hong Kong. AIDS Care 2010; 21:785-95. [PMID: 19806492 DOI: 10.1080/09540120802511968] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adherence to antiretroviral therapy is essential to treatment success for individuals living with HIV/AIDS. Despite the wealth of studies in examining antiretroviral non-adherence, few have distinguished between intentional and unintentional non-adherence. The present study attempted to identify factors associated with adherence, intentional non-adherence, and unintentional non-adherence among HIV+ individuals using a longitudinal design. Dietary instructions and medication schedule were also included to measure the subtleties of antiretroviral adherence. One hundred and two HIV+ patients who were under antiretroviral therapy were recruited in an outpatient clinic in Hong Kong at baseline with six months follow-up. Using the conventional adherence rate, only 12 (11.8%) of participants reported having missed/ altered medication in the past four days. However, using a more comprehensive assessment, only 27 (26.5%) participants were classified as adherers. Results showed that, adherers were significantly older and had higher adherence self-efficacy than those who were unintentional or intentional non-adherers. Participants classified as unintentional non-adherers had longer length of diagnosis and started medication longer than adherers and intentional non-adherers. Participants classified as intentional non-adherers had worse mental health, higher level of self-stigma, and reported higher score in avoidant coping than adherers and unintentional non-adherers. They also scored higher in physical symptoms than adherers. Findings highlight the importance of a reliable, comprehensive measurement for adherence and extend on previous adherence literature that intentional and unintentional non-adherence are separate entities and are associated with different factors. Future research should understand the intentions behind non-adherence and this would serve as an important guide in the development of interventions aimed at improving antiretroviral adherence for HIV+ patients.
Collapse
Affiliation(s)
- Phoenix K H Mo
- Institute of Work, Health and Organisations, University of Nottingham, UK.
| | | |
Collapse
|
16
|
Executive functioning and health: introduction to the special series. Ann Behav Med 2009; 37:101-5. [PMID: 19373516 DOI: 10.1007/s12160-009-9091-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Indexed: 10/20/2022] Open
|
17
|
The relationship between neuropsychological functioning and HAART adherence in HIV-positive adults: a systematic review. J Behav Med 2009; 32:389-405. [PMID: 19291386 DOI: 10.1007/s10865-009-9212-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Accepted: 03/04/2009] [Indexed: 12/24/2022]
Abstract
Combination antiretroviral therapy has helped extend the lives of persons infected with HIV; however, the efficacy of highly active antiretroviral therapy (HAART) regimens depends, in part, on the consistency with which the medications are taken. In this paper, we review 11 empirical studies conducted in Western developed nations that utilized psychometrically valid neuropsychological measures to examine the relationship between cognitive functioning and HAART adherence. In general, impaired neuropsychological functioning--particularly within the domains of executive functioning and problem solving, learning and memory, attention and working memory, and global cognitive functioning--was associated with lower medication adherence across studies. However, inconsistent operationalizations of neuropsychological impairment and medication adherence employed in these studies, as well as the paucity of longitudinal data to support temporal relationships, may attenuate these conclusions. We conclude with a set of research recommendations that may help to improve the rigor of future studies and clarify questions left unanswered due to methodological limitations of existing studies.
Collapse
|