Relationship of Cognitive Function on Medication Adherence and Clinical Outcomes of Geriatric Patients with Diabetic Neuropathy
DOI:
https://doi.org/10.59188/eduvest.v5i2.44735Keywords:
geriatrics, diabetic neuropathy, cognitive function, medication adherence, neuropathy symptomsAbstract
Diabetic neuropathy is a common complication of diabetes mellitus that significantly impacts quality of life and is also prone to cognitive decline exacerbated by diabetes complications. Medication adherence has been shown to slow or prevent cognitive decline. Neuropathy symptoms, neuropathic pain, and sensory disturbances can worsen cognitive function. This study aimed to assess the relationship between cognitive function and medication adherence, as well as clinical outcomes of neuropathy symptoms in geriatric patients with diabetic neuropathy. This observational cross-sectional study involved 217 geriatric patients at RSUD Tebet from June to September 2024. Cognitive function was assessed using the MoCA-Ina questionnaire, and adherence was measured through questionnaires, medical records, and direct observation (MARS-5, MPR, and Pill Count) as well as DNS scoring to assess clinical outcomes of neuropathy symptoms. This study found that women (71,5%) were more likely to experience cognitive decline than men (28,5%). The study found that medication adherence varied by method. Triangulation showed 64.6% non-adherence in cognitive decline versus 35.4% in normal function (OR 1.774, 95% CI: 1.001-3.144). Caregiver presence significantly affected adherence (p=0.011), with a 2.8 times higher risk of non-adherence and a 2.4 times higher risk of neuropathy symptoms in patients without caregivers.
References
Alkethiri, K., Almtroudi, T., Jurays, A. bin, Abanumay, F., Aldammas, M., AlKhodheer, M., Iqbal, M., Habib, S. S., & Bashir, S. (2021). The relationship between type 2 diabetes mellitus with cognitive functions. Heliyon, 7(3), e06358. https://doi.org/10.1016/j.heliyon.2021.e06358
Anghel, L. A., Farcas, A. M., & Oprean, R. N. (2019). An overview of the common methods used to measure treatment adherence. Medicine and Pharmacy Reports. https://doi.org/10.15386/mpr-1201
Austin, J., Klein, K., Mattek, N., & Kaye, J. (2017). Variability in medication taking is associated with cognitive performance in nondemented older adults. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 6(1), 210–213. https://doi.org/10.1016/j.dadm.2017.02.003
Badan Pusat Statistik. (2023). Statistik Penduduk Lanjut Usia 2023. Badan Pusat Statistik, 20, 1–326.
Ba-Tin, L., Strike, P., & Tabet, N. (2011). Diabetic Peripheral Microvascular Complications: Relationship to Cognitive Function. Cardiovascular Psychiatry and Neurology, 2011, 1–7. https://doi.org/10.1155/2011/723434
Bell, T., Franz, C. E., & Kremen, W. S. (2022). Persistence of pain and cognitive impairment in older adults. Journal of the American Geriatrics Society, 70(2), 449–458. https://doi.org/10.1111/jgs.17542
Bondar, A., Popa, A., Papanas, N., Popoviciu, M., Vesa, C., Sabau, M., Daina, C., Stoica, R., Katsiki, N., & Stoian, A. (2021). Diabetic neuropathy: A narrative review of risk factors, classification, screening and current pathogenic treatment options (Review). Experimental and Therapeutic Medicine, 22(1), 690. https://doi.org/10.3892/etm.2021.10122
Brognara, L., Volta, I., Cassano, V. M., Navarro-Flores, E., & Cauli, O. (2020). The Association between Cognitive Impairment and Diabetic Foot Care: Role of Neuropathy and Glycated Hemoglobin. Pathophysiology, 27(1), 14–27. https://doi.org/10.3390/pathophysiology27010003
Choo, E., Jung, M., Shin, J., & Lee, S. (2021). Comparing the Sensitivities of Measures of Adherence to Antihypertensive Drugs Using Korean National Health Insurance Claims Data. Patient Preference and Adherence, Volume 15, 1717–1728. https://doi.org/10.2147/PPA.S322745
Chudiak, A., Uchmanowicz, I., & Mazur, G. (2018). Relation between cognitive impairment and treatment adherence in elderly hypertensive patients. Clinical Interventions in Aging, Volume 13, 1409–1418. https://doi.org/10.2147/CIA.S162701
Gonzales, M. M., Garbarino, V. R., Pollet, E., Palavicini, J. P., Kellogg, D. L., Kraig, E., & Orr, M. E. (2022). Biological aging processes underlying cognitive decline and neurodegenerative disease. Journal of Clinical Investigation, 132(10). https://doi.org/10.1172/JCI158453
Hansen, R. A., Kim, M. M., Song, L., Tu, W., Wu, J., & Murray, M. D. (2009). Adherence: Comparison of Methods to Assess Medication Adherence and Classify Nonadherence. Annals of Pharmacotherapy, 43(3), 413–422. https://doi.org/10.1345/aph.1L496
Hicks, C. W., & Selvin, E. (2019). Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Current Diabetes Reports, 19(10), 86. https://doi.org/10.1007/s11892-019-1212-8
Hoffmann, R., & Lutz, S. U. (2019). The health knowledge mechanism: evidence on the link between education and health lifestyle in the Philippines. The European Journal of Health Economics, 20(1), 27–43. https://doi.org/10.1007/s10198-017-0950-2
Huang, J., Ding, S., Xiong, S., & Liu, Z. (2021). Medication Adherence and Associated Factors in Patients With Type 2 Diabetes: A Structural Equation Model. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.730845
International diabetes federation. (2021). Indonesia diabetes report 2000 — 2045. In IDF Diabetes Atlas 10 edition 2021 (p. 1).
Jermendy, G., Rokszin, G., Fábián, I., Kempler, P., & Wittmann, I. (2023). Morbidity and mortality of patients with diabetic neuropathy treated with pathogenetically oriented alpha-lipoic acid versus symptomatic pharmacotherapies – A nationwide database analysis from Hungary. Diabetes Research and Clinical Practice, 201, 110734. https://doi.org/10.1016/j.diabres.2023.110734
Jose, J., & Bond, C. (2021). Medication Adherence: Still a problem. International Journal of Pharmacy Practice, 29(2), 93–95. https://doi.org/10.1093/ijpp/riaa019
Lin, Y. J., Kao, T. W., & Chen, W. L. (2021). Relationship between peripheral neuropathy and cognitive performance in the elderly population. Medicine (United States), 100(20), E26071. https://doi.org/10.1097/MD.0000000000026071
Lin, Y.-J., Kao, T.-W., & Chen, W.-L. (2021). Relationship between peripheral neuropathy and cognitive performance in the elderly population. Medicine, 100(20), e26071. https://doi.org/10.1097/MD.0000000000026071
Ma, T., Liao, J., Ye, Y., & Li, J. (2024). Social support and cognitive activity and their associations with incident cognitive impairment in cognitively normal older adults. BMC Geriatrics, 24(1), 38. https://doi.org/10.1186/s12877-024-04655-5
Matyas, N., Keser Aschenberger, F., Wagner, G., Teufer, B., Auer, S., Gisinger, C., Kil, M., Klerings, I., & Gartlehner, G. (2019). Continuing education for the prevention of mild cognitive impairment and Alzheimer’s-type dementia: a systematic review and overview of systematic reviews. BMJ Open, 9(7), e027719. https://doi.org/10.1136/bmjopen-2018-027719
Meijer, J.-W. G., Bosma, E., Lefrandt, J. D., Links, T. P., Smit, A. J., Stewart, R. E., van der Hoeven, J. H., & Hoogenberg, K. (2003). Clinical Diagnosis of Diabetic Polyneuropathy With the Diabetic Neuropathy Symptom and Diabetic Neuropathy Examination Scores. Diabetes Care, 26(3), 697–701. https://doi.org/10.2337/diacare.26.3.697
Moreira, R. O., Soldera, A. L., Cury, B., Meireles, C., & Kupfer, R. (2015). Is cognitive impairment associated with the presence and severity of peripheral neuropathy in patients with type 2 diabetes mellitus? Diabetology and Metabolic Syndrome, 7(1), 1–4. https://doi.org/10.1186/s13098-015-0045-0
Mufidah, B. (2022). Hubungan Neuropati Diabetik dengan Fungsi Kognitif pada Pasien Diabetes Melitus Tipe 2 di RSUD Prof. Dr. Margono Soekarjo. Skripsi Thesis, Universitas Jenderal Soedirman.Http://Repository.Unsoed.Ac.Id/13195/.
Palomo-Osuna, J., Dueñas, M., Naranjo, C., De Sola, H., Salazar, A., & Failde, I. (2022). Factors related to cognitive function in type-2 diabetes and neuropathic pain patients, the role of mood and sleep disorders in this relationship. Scientific Reports, 12(1), 15442. https://doi.org/10.1038/s41598-022-18949-4
Pillemer, S. C., & Holtzer, R. (2016). The differential relationships of dimensions of perceived social support with cognitive function among older adults. Aging & Mental Health, 20(7), 727–735. https://doi.org/10.1080/13607863.2015.1033683
Pop-Busui, R., Ang, L., Boulton, A., Feldman, E., Marcus, R., Mizokami-Stout, K., Singleton, J. R., & Ziegler, D. (2022). Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy. ADA Clinical Compendia, 2022(1), 1–32. https://doi.org/10.2337/db2022-01
Rachman, A., Sauriasari, R., Syafhan, N. F., Prawiroharjo, P., & Risni, H. W. (2022). Cognitive Function in Type 2 Diabetes Mellitus Patients Taking Metformin and Metformin-Sulfonylurea. Kesmas, 17(4), 270–278. https://doi.org/10.21109/kesmas.v17i4.6303
Rahmawati, A., & Hargono, A. (2018). Dominant Factor of Diabetic Neuropathy on Diabetes Mellitus Type 2 Patients. Jurnal Berkala Epidemiologi, 6(1), 60. https://doi.org/10.20473/jbe.v6i12018.60-68
Randväli, M., Toomsoo, T., & Šteinmiller, J. (2024). The Main Risk Factors in Type 2 Diabetes for Cognitive Dysfunction, Depression, and Psychosocial Problems: A Systematic Review. Diabetology, 5(1), 40–59. https://doi.org/10.3390/diabetology5010004
Rhalimi, M., Rauss, A., & Housieaux, E. (2018). Drug-related problems identified during geriatric medication review in the community pharmacy. International Journal of Clinical Pharmacy, 40(1). https://doi.org/10.1007/s11096-017-0571-y
Russell, J. K., Jones, C. K., & Newhouse, P. A. (2019). The Role of Estrogen in Brain and Cognitive Aging. Neurotherapeutics, 16(3), 649–665. https://doi.org/10.1007/s13311-019-00766-9
Scheurer, D., Choudhry, N., Swanton, K. A., Matlin, O., & Shrank, W. (2012). Association between different types of social support and medication adherence. The American Journal of Managed Care, 18(12), e461-7.
Umegaki, H. (2020). Association of polypharmacy with decline in quality of life in mild cognitive impairment and mild dementia. Geriatrics & Gerontology International, 20(9), 840–842. https://doi.org/10.1111/ggi.13988
Wang, L., Gao, P., Zhang, M., Huang, Z., Zhang, D., Deng, Q., Li, Y., Zhao, Z., Qin, X., Jin, D., Zhou, M., Tang, X., Hu, Y., & Wang, L. (2017). Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA, 317(24), 2515. https://doi.org/10.1001/jama.2017.7596
Yang, Z., Chen, R., Zhang, Y., Huang, Y., Hong, T., Sun, F., Ji, L., & Zhan, S. (2018). Scoring systems to screen for diabetic peripheral neuropathy. Cochrane Database of Systematic Reviews, 2018(7). https://doi.org/10.1002/14651858.CD010974.pub2
Zhang, L., Yang, J., Liao, Z., Zhao, X., Hu, X., Zhu, W., & Zhang, Z. (2019). Association between Diabetes and Cognitive Function among People over 45 Years Old in China: A Cross-Sectional Study. International Journal of Environmental Research and Public Health, 16(7), 1294. https://doi.org/10.3390/ijerph16071294
Zhong, T., Li, S., Liu, P., Wang, Y., & Chen, L. (2024). The impact of education and occupation on cognitive impairment: a cross-sectional study in China. Frontiers in Aging Neuroscience, 16. https://doi.org/10.3389/fnagi.2024.1435626
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