Research Article
Cognitive Function and Medication Adherence in Older Adults With H-Type Hypertension: The Mediating Effect of Metamemory
Journal of Gerontological Nursing, 2024;50(6):44–52
Abstract
Purpose:
Medication adherence in adults with H-type hypertension plays a crucial role in lowering blood pressure and treating complications. Cognitive function has been identified as a significant influencing factor for medication adherence, whereas excessive levels of homocysteine can impair cognitive function. Metamemory, which is influenced by cognitive function, also affects medication adherence. However, the complex relationship among these factors remains poorly understood among adults with H-type hypertension. Therefore, we hypothesize that metamemory serves as a mediator for the impact of cognitive function on medication adherence.
Method:
A total of 232 adults with H-type hypertension were enrolled to provide cognitive function scores, metamemory scores, and medication adherence rates.
Results:
A pairwise correlation exists among cognitive function, metamemory, and medication adherence. Metamemory partially mediates (57.5%) the relationship between cognitive function and medication adherence.
Conclusion:
Our findings suggest that interventions targeting improvements in metamemory may enhance medication adherence among individuals with H-type hypertension. [Journal of Gerontological Nursing, 50(6), 44–52.]
- (2022). Metamemory mediates the protective effect of cognitive reserve on episodic memory during aging. Acta Psychologica, 228, 103627.
10.1016/j.actpsy.2022.103627 PMID:35688111 > Crossref MedlineGoogle Scholar - (2017). Drug adherence in hypertension. Pharmacological Research, 125(Pt B), 142–149.
10.1016/j.phrs.2017.08.015 > Crossref MedlineGoogle Scholar - (2017). Evaluation of reliability and validity of the Chinese version of the MMAS-8 scale in patients with hypertension. Electronic Journal of Clinical Medical Literature, 4(39), 7566–7567.
10.16281/j.cnki.jocml.2017.39.028 > CrossrefGoogle Scholar - . (2008). Metacognition. Sage. > Google Scholar
- (2022). Effects of the two-dimensional structure of trust on patient adherence to medication and nonpharmaceutical treatment: A cross-sectional study of rural patients with essential hypertension in China. Frontiers in Public Health, 10, 818426.
10.3389/fpubh.2022.818426 PMID:35309202 > Crossref MedlineGoogle Scholar - (1975). “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician”. Journal of Psychiatric Research, 12(3), 189–198.
10.1016/0022-3956(75)90026-6 PMID:1202204 > Crossref MedlineGoogle Scholar - (2018). Improving medication understanding and adherence using principles of memory and meta-cognition. Policy Insights from the Behavioral and Brain Sciences, 5(2), 147–154.
10.1177/2372732218781643 PMID:31552287 > Crossref MedlineGoogle Scholar - (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford. > Google Scholar
- . (2010). ASH position paper: Adherence and persistence with taking medication to control high blood pressure. Journal of Clinical Hypertension (Greenwich, Conn.), 12(10), 757–764.
10.1111/j.1751-7176.2010.00356.x PMID:21029338 > Crossref MedlineGoogle Scholar - (2019). The impact of memory-strategy training interventions on participant-reported outcomes in healthy older adults: A systematic review and meta-analysis. Psychology and Aging, 34(4), 587–597.
10.1037/pag0000340 PMID:30896195 > Crossref MedlineGoogle Scholar - (2019). Homocysteine modification in protein structure/function and human disease. Physiological Reviews, 99(1), 555–604.
10.1152/physrev.00003.2018 PMID:30427275 > Crossref MedlineGoogle Scholar - (2021). Influential factors in adherence to the therapeutic regime in patients with type 2 diabetes and hypertension. Diabetes Research and Clinical Practice, 173, 108693.
10.1016/j.diabres.2021.108693 PMID:33592212 > Crossref MedlineGoogle Scholar - (1988). A Chinese version of the Mini-Mental State Examination: Impact of illiteracy in a Shanghai dementia survey. Journal of Clinical Epidemiology, 41(10), 971–978.
10.1016/0895-4356(88)90034-0 PMID:3193141 > Crossref MedlineGoogle Scholar - (2003). Partial compliance and patient consequences in schizophrenia: Our patients can do better. The Journal of Clinical Psychiatry, 64(11), 1308–1315.
10.4088/JCP.v64n1105 PMID:14658944 > Crossref MedlineGoogle Scholar - (2022). Global burden, regional differences, trends, and health consequences of medication nonadherence for hypertension during 2010 to 2020: A meta-analysis involving 27 million patients. Journal of the American Heart Association, 11(17), e026582.
10.1161/JAHA.122.026582 PMID:36056737 > Crossref MedlineGoogle Scholar - (2010). Effects of cognitive training based on metamemory and mental images. Dementia & Neuropsychologia, 4(2), 114–119.
10.1590/S1980-57642010DN40200007 PMID:29213673 > Crossref MedlineGoogle Scholar - . (2011). 2010 Chinese guidelines for the management of hypertension [article in Chinese]. Zhonghua Xin Xue Guan Bing Za Zhi, 39(7), 579–615. PMID:
22088239 > MedlineGoogle Scholar - . (2006). Effect of subjective reasoning and neuro-cognition on medication adherence for persons with schizophrenia. Psychiatric Services (Washington, D.C.), 57(8), 1203–1205.
10.1176/ps.2006.57.8.1203 PMID:16870974 > Crossref MedlineGoogle Scholar - (2015). Relationships among medication adherence, insight, and neurocognition in chronic schizophrenia. Psychiatry and Clinical Neurosciences, 69(5), 298–304.
10.1111/pcn.12272 PMID:25600955 > Crossref MedlineGoogle Scholar - . (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants. (2021). Lancet, 398(10304), 957–980.
10.1016/S0140-6736(21)01330-1 > Crossref MedlineGoogle Scholar - (2012). Association between the 8-item Morisky Medication Adherence Scale (MMAS-8) and blood pressure control. Arquivos Brasileiros de Cardiologia, 99, 649–658.
10.1590/s0066-782x2012005000053 PMID:22688844 > Crossref MedlineGoogle Scholar - (2013). Predictors of adherence to medication in older Korean patients with hypertension. European Journal of Cardiovascular Nursing, 12(1), 17–24.
10.1016/j.ejcnurse.2011.05.006 PMID:21704563 > Crossref MedlineGoogle Scholar - (2017). Elevated homocysteine concentrations decrease the antihypertensive effect of angiotensin-converting enzyme inhibitors in hypertensive patients. Arteriosclerosis, Thrombosis, and Vascular Biology, 37(1), 166–172.
10.1161/ATVBAHA.116.308515 PMID:27834686 > Crossref MedlineGoogle Scholar - (2014). Prospective memory in schizophrenia: Relationship to medication management skills, neurocognition, and symptoms in individuals with schizophrenia. Neuropsychology, 28(3), 359–365.
10.1037/neu0000040 PMID:24188118 > Crossref MedlineGoogle Scholar - (2002). Psychometric properties of a new metamemory questionnaire for older adults. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 57(1), 19–27.
10.1093/geronb/57.1.P19 PMID:11773220 > Crossref MedlineGoogle Scholar - (2013). The efficacy of a multi-factorial memory training in older adults living in residential care settings. International Psychogeriatrics, 25(11), 1885–1897.
10.1017/S1041610213001154 PMID:23899952 > Crossref MedlineGoogle Scholar - (1989). The application of the Chinese version of the Mini-Mental State Examination (MMSE). Shanghai Jingshen Yixue, 7(3), 108–111. > Google Scholar
- (2019). Gender differences in the association between migration and cognitive function among older adults in China and India. Archives of Gerontology and Geriatrics, 81, 31–38.
10.1016/j.archger.2018.11.011 PMID:30502567 > Crossref MedlineGoogle Scholar - (2018). Correlation between the degree of cognitive impairment and levels of inflammation and oxidative stress factors in patients with H-type hypertension. Chinese Journal of Hypertension, 26(9), 871–874.
10.16439/j.cnki.1673-7245.2018.09.024 > CrossrefGoogle Scholar
