Cognition-symptom-perception relationship studied in older adults with bronchial asthma

In older adults with asthma, cognitive impairment is not associated with the perception of asthma symptoms, according to study results published in the Journal of Asthma. In these individuals, symptom perception is neither a mediator nor a moderator of the relationship between cognitive abilities and asthma drug adherence.

In a longitudinal cohort study, researchers attempted to examine the relationship between cognitive functioning, perception of asthma symptoms, and asthma self-management in a group of older adults with asthma by first testing the theory that poor performance is related to poor drug compliance.

Researchers then investigated whether underperception of symptoms of asthma was associated with poor performance in measurements of general cognitive function. Finally, they assessed whether underperception of symptoms of asthma might mediate the link between poor performance in measurements of general cognitive function and non-compliance with medication.

All data was collected in cross-section during the baseline visits between January 2017 and January 2020. Formally trained research assistants administered cognitive measures during the baseline session. Self-reported medication adherence, demographic information, and other questionnaires assessing asthma control (e.g., Asthma Control Questionnaire, Juniper Asthma Quality of Life Questionnaire) and depression (Geriatric Depression Scale) were also obtained at this visit.

A total of 334 participants who were 60 years or older and had persistent or severe asthma were enrolled in the study. The mean age of the participants was 67.9 years; 51.2% of participants were Hispanic, 24.9% were Black, and 84.4% were women.

The cognitive measures assessed included general cognition, attention, processing speed, executive functions, language, and memory. Asthma self-management measures were self-reported, with control drug adherence measured electronically. Underperception of asthma symptoms was assessed by participants for 6 weeks by entering estimates of their maximum expiratory flow into a programmable peak flow meter.

The results showed that self-reported drug non-compliance was significantly associated with impairment in several areas, including general cognitive function (odds ratio) [OR]0.91; 95% CI, 0.86-0.96; P <0.001), memory (OR 0.96; 95% CI 0.94-0.98; P = 0.001), attention / processing speed (OR 1.02; 95% CI 1.00-1.04; P. = 0.03) and working memory (OR 0.98; 95% CI 0.95-0.99; P = 0.04).

According to fitted analyzes, patients with impaired general cognitive function and memory had lower ORs for self-reported non-compliance and memory (OR 0.90; 95% CI 0.83-0.96; P = 0.002 and OR 0.96; 95% CI 0.93) -0.98; P = 0.005). However, cognitive impairment was not associated with electronically measured non-compliance or underperception of asthma symptoms.

In addition, the modeling of structural equations showed that while cognitive impairments were significantly associated with adherence (P = 0.04), the underperception of asthma symptoms did not convey this relationship.

Limitations of the study included those associated with self-reporting measures, the potential for objective measures not to adequately capture participant adherence, a lack of data collection between medical appointments, and a lack of generalizability for even older adults with more severe cognitive impairment.

The researchers concluded that additional research into these relationships is needed to understand the role that confounders play in these analyzes.


Becker JH, Feldman JM, Arora A, Busse PJ, Wisnivesky JP, Federman AD. Cognition, symptom perception, and medication non-compliance in older adults with asthma. Published online November 28, 2020. J Asthma. doi: 10.1080 / 02770903.2020.1856867

This article originally appeared on Pulmonology Advisor

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