Adherence to treatment with injectable immunomodulators in patients with multiple sclerosis and cognitive disorder

Abstract

IntroductionMultiple sclerosis (MS) is an inflammatory, demyelinating, and neurodegenerative disease that affects the central nervous system. Adherence to treatment is essential to modify the course of the disease. Cognitive impairment affects up to 70% of these patients and is a limitation for administration and adherence to treatment. ObjectiveThe main objective was to assess the degree of adherence to treatment in patients with MS and cognitive impairment. Secondary objectives were to describe the tools that can influence adherence to treatment and to evaluate the effectiveness of the technological devices used to alert the patient that he/she must self-inject. MethodThe method consisted of a descriptive, retrospective, and cross-sectional pilot study. It was carried out in the MS clinic of the Torrecárdenas University Hospital from December 2018 to September 2019. The sample included 20 patients diagnosed with MS currently treated with immunomodulatory injectable drugs for at least 6 months. The Symbol Digit Modalities Test (SDMT) was used to assess cognitive impairment and to determine adherence, patients answered the Morisky-Green test (MG). ResultsTwenty patients (8 men and 12 women) were included over 10 months with MS and cognitive impairment (SDMT score less than 50th percentile). Regarding gender-differentiated adherence, 75% of men were not adherent to treatment; by contrast, 66.6% of women were com-pliant with the dosage schedule. There were no statistically significant differences in terms of differentiated adherence by type of treatment. The main methods used to promote adherence were: 10% calendar, 20% family members, and 30% alarms as reminder. Discussion and conclusionAdherence results show a predominance of adherence in women, even with cognitive impairment. This reinforces our initial hypothesis that relates good therapeutic adherence to lesser progression of cognitive impairment in MS. As a preventive measure, we would like to emphasize the importance of the role of the nursing team in detecting cognitive impairment and in assessing adherence to treatment.