title: Cognitive factors associated with adherence to oral antiestrogen therapy: results from the cognition in the study of tamoxifen and raloxifene (Co-STAR) study.
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.
authors.affiliation: Section on Hematology and Oncology, Wake Forest Baptist Health, Medical Center Blvd., Winston-Salem, NC 27157. hklepin@wakehealth.edu.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Klepin
authors.forename: Ann M
authors.initials: AM
authors.lastname: Geiger
authors.forename: Hanna
authors.initials: H
authors.lastname: Bandos
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Costantino
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Rapp
authors.forename: Kaycee M
authors.initials: KM
authors.lastname: Sink
authors.forename: Julia A
authors.initials: JA
authors.lastname: Lawrence
authors.forename: Hal H
authors.initials: HH
authors.lastname: Atkinson
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
mesh_terms: D000368:Aged; D016588:Anticarcinogenic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000517:prevention & control*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D016015:Logistic Models; D055118:Medication Adherence; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use*; D012306:Risk; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D016588:Anticarcinogenic Agents; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride