Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Mar;59(3):607-615.
doi: 10.1080/02770903.2020.1856867. Epub 2020 Dec 7.

Cognition, symptom perception, and medication non-adherence in older adults with asthma

Jacqueline H Becker  1 , Jonathan M Feldman  2   3 , Arushi Arora  1 , Paula J Busse  1 , Juan P Wisnivesky  1 , Alex D Federman  1   4
Affiliations

Cognition, symptom perception, and medication non-adherence in older adults with asthma

Jacqueline H Becker et al. J Asthma. 2022 Mar.

Abstract

Background: Cognitive impairment (CI) is highly prevalent in elderly asthmatics and is associated with worse asthma self-management (SM) and outcomes. CI may also explain why older adults may under-perceive asthma symptoms. We hypothesized that CI would be associated with low medication adherence and asthma symptom under-perception (ASP). We also hypothesized that ASP would mediate the relationship between CI and medication adherence.

Methods: Participants of this longitudinal cohort study were asthmatics (N = 334) ≥60 years (51% Hispanic, 25% Black). Cognitive measures assessed general cognition, attention, processing speed, executive functioning, memory, and language. Measures of SM were self-reported and electronically measured adherence to controller medications. ASP was assessed for 6 weeks by participants entering estimates of peak expiratory flow (PEF) into a programmable peak flow meter, followed by PEF blows. Participants were blinded to actual PEF values. Percentage of time that participants were in the over-perception zone was calculated as an average.

Results: In regression analyses, those with impairments in memory and general cognition had lower odds ratios (OR) for self-reported non-adherence (OR: 0.96, 95% CI 0.93 - 0.98 & OR: 0.90, 95% CI 0.83 - 0.96, respectively). CI was not associated with electronically measured non-adherence or ASP. In structural equation modeling, while CI was associated with adherence (β = 0.04, SE = 0.021, p = 0.04), ASP did not mediate this relationship.

Conclusions: While results confirmed the importance of cognition in asthma SM, these findings were not linked to ASP. Future analyses are needed to understand the role of confounding factors.

Keywords: Asthma; adherence; cognition; elderly; symptom perception.

PubMed Disclaimer

Conflict of interest statement

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

References

    1. Roberts R, Knopman DS. Classification and epidemiology of MCI. Clin Geriatr Med. 2013;29(4):753–772. doi:10.1016/j.cger.2013.07.003. - DOI - PMC - PubMed
    1. Caldera-Alvarado G, Khan DA, DeFina LF, Pieper A, Brown ES. Relationship between asthma and cognition: the Cooper Center Longitudinal Study. Allergy. 2013;68(4):545–548. doi:10.1111/all.12125. - DOI - PubMed
    1. Kroll JL, Steele AM, Pinkham AE, Choi C, Khan DA, Patel SV, Chen JR, Aslan S, Sherwood Brown E, Ritz T. Hippocampal metabolites in asthma and their implications for cognitive function. Neuroimage Clin. 2018;19:213–221. doi:10.1016/j.nicl.2018.04.012. - DOI - PMC - PubMed
    1. Creer TL. Behavioral and Cognitive Processes in the Self-Management of Asthma. J Asthma. 2008;45(2): 81–94. doi:10.1080/02770900701247236. - DOI - PubMed
    1. Krauskopf KA, Sofianou A, Goel MS, Wolf MS, Wilson EAH, Martynenko ME, Halm EA, Leventhal H, Feldman JM, Federman AD, et al. Depressive symptoms, low adherence, and poor asthma outcomes in the elderly. J Asthma. 2013;50(3):260–266. doi:10.3109/02770903.2012.757779. - DOI - PubMed

Publication types

Substances