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J Behav Med DOI 10.1007/s10865-010-9247-y

Treatment adherence in multiple sclerosis: association with emotional status, personality, and cognition
Jared M. Bruce • Laura M. Hancock • Peter Arnett Sharon Lynch
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Received: September 2, 2009 / Accepted: January 9, 2010 Ó Springer Science+Business Media, LLC 2010

Abstract The purpose of the present study was to prospectively examine theassociation between treatment adherence and common neuropsychiatric symptoms in multiple sclerosis (MS). Patients underwent a thorough psychiatric and neuropsychological evaluation at the outset of the study. Patient adherence to disease modifying therapies was then tracked for 8 weeks using self-report, a medication diary, and an electronic monitoring device that recorded needle disposals. Resultsindicated that MS patients with current mood or anxiety disorders were almost five times as likely as MS patients with no psychiatric diagnosis to exhibit problems adhering to their disease modifying therapies. Poor adherence was also associated with memory difficulties, anxiety, depression, neuroticism, and low conscientiousness. Findings highlight the importance of conducting a thoroughpsychiatric and neuropsychological evaluation when clinicians suspect poor adherence to disease modifying therapies. Pharmacological or psychotherapeutic treatment of mood/anxiety disorders, use of scheduled reminders, and/or increased organization and structure may lead to improved treatment adherence in MS.

Keywords Multiple sclerosis Á Adherence Á MEMS Á Cognition Á Memory Á Depression Á AnxietyIntroduction Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that has significant cognitive and emotional sequelae (Arnett 2003). More than 50% of MS patients experience problems with memory, executive functions, attention, or speed of information processing (Rao et al. 1991a, b). Point prevalence rates for mood disorders among MS patients range from 14 to 57 percent(Mohr and Cox 2001). In addition, roughly 35% of MS patients endorse chronic worry and lifetime prevalence for generalized anxiety disorder in MS has been estimated at 20% (Bruce and Arnett 2009; Korostil and Feinstein 2007). Personality changes, including increased neuroticism and decreased empathy, agreeableness, and conscientiousness have also been observed (Benedict et al. 2001). MS-relatedcognitive and emotional difficulties are known to be associated with problems managing independent activities of daily living, poorer vocational status, and reduced quality of life (Benedict et al. 2005; Higginson et al. 2000; Rao et al. 1991a, b). However, no studies have thoroughly examined the association between cognitive and emotional changes in MS and treatment adherence. The purpose of thepresent study was to examine the association between prospective medication adherence and common cognitive, emotional, and personality sequelae of MS. The World Health Organization has suggested that improved treatment adherence would have a larger impact on society and health than most therapeutic advances (WHO 2003). Across multiple non-MS disease groups, between 25 and 50% of patients do notproperly adhere to their

J. M. Bruce (&) Á L. M. Hancock Department of Psychology, University of Missouri–Kansas City, 4825 Troost Building, Suite 111G, Kansas City, MO 64110, USA e-mail: brucejm@umkc.edu P. Arnett Department of Psychology, The Pennsylvania State University, University Park, PA, USA S. Lynch Landon Center on Aging, University of Kansas Medical Center, Kansas City, KS, USA

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prescribed treatment regimens (Bosworth 2006). Poor medication adherence is common among patients with depression, anxiety, diabetes, HIV, coronary artery disease, asthma, and various types of dementia (Altice and Friedland 1998; Brauner et al. 2000; Cramer 2004; Newby et al. 2006; Pampallona et al. 2002; Stein et al. 2006; Wetherell and Unutzer 2003). These adherence difficulties...