title: Systematic review on factors associated with medication non-adherence in Parkinson's disease.
abstract: BACKGROUND
  Medication non-adherence is prevalent in Parkinson's disease (PD) and results in substantial motor dysfunction. Although various approaches have been suggested to address non-adherence in PD, good quality evidence of associated factors is limited.
  
  
  OBJECTIVE
  To systematically review the literature on clinical and demographic factors associated with medication non-adherence in PD.
  
  
  METHODS
  We searched five online databases in April 2011 (updated in January 2012): MEDLINE, EMBASE, AMED, PsycINFO and CINAHL for studies reporting data on factors associated with medication non-adherence in people with idiopathic PD. Bibliographies were hand searched to acquire records not identified electronically. Two reviewers independently assessed identified articles for potential inclusion. Data extraction was undertaken using a standardised data extraction form. Methodological quality was assessed against a specially designed quality indicator tool emphasising the detection of threats to internal validity.
  
  
  RESULTS
  We identified 1880 records of which six met inclusion criteria. A total of 772 PD patients were included (mean age 62 years, males 61%). We identified eleven factors (six clinical and five demographic) associated with non-adherence. We ranked each factor in order by weight of overall evidence: mood disorders, cognition, poor symptom control/QoL, younger age/longer disease duration, regimen complexity/polypharmacy, risk taking behaviours, poor knowledge of PD/education, lack of spouse/partner, low income, maintaining employment and gender.
  
  
  CONCLUSIONS
  Clinicians should be aware of factors associated with medication non-adherence in PD. Targeted interventions should be developed and investigated to establish if addressing factors associated with non-adherence in PD leads to greater medication adherence.
authors.affiliation: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ, UK. d.daley@uea.ac.uk
authors.forename: David James
authors.initials: DJ
authors.lastname: Daley
authors.forename: Phyo Kyaw
authors.initials: PK
authors.lastname: Myint
authors.forename: Richard John
authors.initials: RJ
authors.lastname: Gray
authors.forename: Katherine Helen O'Leary
authors.initials: KH
authors.lastname: Deane
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D012307:Risk Factors; D016903:Drug Monitoring
chemical_list: D000978:Antiparkinson Agents