Neuropsychological functioning, age, and medication adherence in bipolar disorder.

N Corréard ,Sébastien Gard,Paul Roux,Marion Leboyer,Chantal Henry,Frank Bellivier,Benjamin Fredembach,Julia-Lou Consoloni,Raoul Belzeaux,Sophie Job,Mircea Polosan,Thierry Bougerol,Lucile Matos,Anne-Sophie Homassel,Philippe Courtet,Aurélie Raust,Romain Guillot,J Loftus ,Jean‐Pierre Kahn ,Jean‐Michel Azorin ,Katia M’baïlara ,Bruno Étain ,Émilie Olié ,I Medecin ,M Carminati

doi:10.1371/journal.pone.0184313

Abstract

ObjectivesPoor 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.MethodsIn 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.ResultsA 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).ConclusionsWe 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.

Highlights

Bipolar disorder (BD) is a chronic and severe mental disorder often characterized by residual symptoms as well as heterogeneous impairment of cognitive functioning [1,2,3]
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 and strictly euthymic
We found an age-specific relationship between cognitive functioning and adherence in patients with BD

Summary

Introduction

Bipolar disorder (BD) is a chronic and severe mental disorder often characterized by residual symptoms as well as heterogeneous impairment of cognitive functioning [1,2,3]. It is associated with more relapses, recurrences and an increased risk of suicide [7, 8]. Several factors have been related to low treatment adherence in BD [5, 6, 9]. We and others have demonstrated that male gender, depressive residual symptoms, and a higher level of medication side effects were associated with treatment nonadherence. Comorbidity such as substance use disorder has been strongly associated with low treatment adherence in BD [10, 11]. An increase in age of patients was linked with increased adherence to medication [9, 12, 13]

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Conclusion