COGNITIVE IMPAIRMENT AND MEDICATION ADHERENCE IN PATIENTS WITH CORONARY ARTERY DISEASE: A PROSPECTIVE COHORT STUDY USING MOCA AND ACDS
Author(s)
Manoj Kumar Mudigubba, PharmD, PhD, MPH;
Raghavendra Institute of Pharmaceutical education and Research (RIPER), Associate Professor & HoD, Anantapur, India
Raghavendra Institute of Pharmaceutical education and Research (RIPER), Associate Professor & HoD, Anantapur, India
OBJECTIVES: This study aimed to assess the prevalence of cognitive impairment among CAD patients using the MOCA and to examine its impact on medication adherence measured by the ACDS.
METHODS: It is a prospective cohort study conducted at a tertiary-care teaching hospital in India over a 12-month period, which enrolled 226 clinically stable CAD patients aged 18 to 65 years. Cognitive function was assessed during hospitalization with MoCA, and medication adherence was evaluated three months post-discharge using the ACDS. Chi-square tests, Pearson’s correlation, and logistic regression analyses (p < 0.05) were used to assess associations between cognitive function and medication adherence.
RESULTS: In this study of 226 CAD patients (Mean age 50.1 ± 9.6 years; 64.2% male), cognitive impairment (MOCA <26) was observed in 29.2% (n=66). Patients with cognitive impairment had significantly lower MOCA scores (21.16 ± 3.71 vs 27.98 ± 0.89) and poorer medication adherence (ACDS 23.66 ± 3.79 vs 26.42 ± 3.24) than those with normal cognition. Overall, 78.7% of cognitively impaired patients fell into the poor to medium adherence categories. A moderate positive correlation between MOCA and ACDS scores was found in the cognitively impaired group (r=0.312, p=0.011), whereas no significant correlation was observed in cognitively normal patients (r=0.137, p=0.084). Binary logistic regression showed that cognitive status was a significant predictor of good versus poor adherence (OR=0.11, 95%CI: 0.04-0.29, p<0.001), indicating that preserved cognitive function substantially increased the likelihood of achieving high medication adherence.
CONCLUSIONS: Cognitive impairment was common in CAD patients and was strongly associated with poorer medication adherence. Patients with cognitive impairment were substantially more likely to exhibit medium to poor adherence, highlighting cognition as a key determinant of clinical outcomes. These findings support the routine incorporation of cognitive screening into CAD care and highlight the need for targeted adherence-support strategies for cognitively vulnerable patients to improve clinical outcomes.
METHODS: It is a prospective cohort study conducted at a tertiary-care teaching hospital in India over a 12-month period, which enrolled 226 clinically stable CAD patients aged 18 to 65 years. Cognitive function was assessed during hospitalization with MoCA, and medication adherence was evaluated three months post-discharge using the ACDS. Chi-square tests, Pearson’s correlation, and logistic regression analyses (p < 0.05) were used to assess associations between cognitive function and medication adherence.
RESULTS: In this study of 226 CAD patients (Mean age 50.1 ± 9.6 years; 64.2% male), cognitive impairment (MOCA <26) was observed in 29.2% (n=66). Patients with cognitive impairment had significantly lower MOCA scores (21.16 ± 3.71 vs 27.98 ± 0.89) and poorer medication adherence (ACDS 23.66 ± 3.79 vs 26.42 ± 3.24) than those with normal cognition. Overall, 78.7% of cognitively impaired patients fell into the poor to medium adherence categories. A moderate positive correlation between MOCA and ACDS scores was found in the cognitively impaired group (r=0.312, p=0.011), whereas no significant correlation was observed in cognitively normal patients (r=0.137, p=0.084). Binary logistic regression showed that cognitive status was a significant predictor of good versus poor adherence (OR=0.11, 95%CI: 0.04-0.29, p<0.001), indicating that preserved cognitive function substantially increased the likelihood of achieving high medication adherence.
CONCLUSIONS: Cognitive impairment was common in CAD patients and was strongly associated with poorer medication adherence. Patients with cognitive impairment were substantially more likely to exhibit medium to poor adherence, highlighting cognition as a key determinant of clinical outcomes. These findings support the routine incorporation of cognitive screening into CAD care and highlight the need for targeted adherence-support strategies for cognitively vulnerable patients to improve clinical outcomes.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH90
Topic
Epidemiology & Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)