title: An evaluation of the impact of memory and mood on antiepileptic drug adherence.
abstract: BACKGROUND
  Antiepileptic drugs are the mainstay of treatment for patients with epilepsy. Adherence to the prescribed regimen is a major factor in achieving a reduced seizure burden, which can decrease morbidity and mortality. Patients with epilepsy oftentimes complain about difficulty with memory. Because little is known about the relationship between memory and mood and adherence, the purpose of this project was to determine the impact of the confounding factors of memory and mood on antiepileptic drug adherence in patients with epilepsy.
  
  
  METHODS
  One hundred adult patients with epilepsy were recruited from the outpatient neurology clinic for this cross-sectional study. Patients who met the inclusion criteria completed measures of subjective memory (subset of 6 memory questions from the QOLIE-89) and objective memory (Hopkins Verbal Learning Test - Revised), subjective adherence (Morisky scale) and objective adherence (medication possession ratio), and mood (Neurological Disorders Depression Inventory for Epilepsy). Refill records from each patient's community pharmacy were used to objectively assess adherence. Medication possession ratios were calculated based on the antiepileptic drug refill records over the previous 6months. Patients were considered adherent if their MPR was >80%.
  
  
  RESULTS
  Women made up the majority of the sample (n=59), and, on average, patients had been living with epilepsy for nearly 20years. Approximately 40% of the sample were on antiepileptic drug monotherapy; most patients (>70%) took their antiepileptic drugs twice daily, and the mean number of total medications was 4.25±2.98. Based on the objective measure of adherence, 35% of the patients were nonadherent. Patients self-reported better adherence than what was objectively measured. Only the retention metric of the objective memory measure differentiated adherent patients from nonadherent patients. Patients in the adherent group had significantly lower depression scores (indicating better mood) compared with those in the nonadherent group (p=0.04).
  
  
  CONCLUSIONS
  Objective memory measures were not robustly correlated with adherence. However, we observed that patients with higher depressed mood scores were more likely to be nonadherent. By targeting patients with epilepsy and comorbid depression, practitioners may identify patients at greatest risk of nonadherence and subsequent harm.
authors.affiliation: Ohio State University College of Pharmacy, Columbus, OH 43210, USA; Ohio State University College of Medicine, Columbus, OH 43210, USA. Electronic address: McAuley.5@osu.edu.
authors.forename: James W
authors.initials: JW
authors.lastname: McAuley
authors.affiliation: Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Passen
authors.affiliation: Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Prusa
authors.affiliation: Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
authors.forename: Joanne
authors.initials: J
authors.lastname: Dixon
authors.affiliation: Ohio State University College of Medicine, Columbus, OH 43210, USA.
authors.forename: Sheri
authors.initials: S
authors.lastname: Cotterman-Hart
authors.affiliation: Ohio State University College of Medicine, Columbus, OH 43210, USA; Ohio State University College of Pharmacy, Columbus, OH 43210, USA.
authors.forename: Bassel F
authors.initials: BF
authors.lastname: Shneker
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects*; D000927:Anticonvulsants / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008568:Memory / Q000187:drug effects*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life; D012640:Seizures / Q000188:drug therapy / Q000453:epidemiology; D012959:Socioeconomic Factors; D014706:Verbal Learning / Q000187:drug effects
chemical_list: D000927:Anticonvulsants
keywords: Adherence; Antiepileptic drug; Depression; Medication possession ratio; Memory; Mood; Pharmacy