Royal College of Surgeons in Ireland
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Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort

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Version 2 2022-01-24, 15:11
Version 1 2019-11-22, 15:35
journal contribution
posted on 2022-01-24, 15:11 authored by Daniela Rohde, Kathleen BennettKathleen Bennett, Eva Gaynor, Margaret Large, Linda BrewerLinda Brewer, Lisa MellonLisa Mellon, David WilliamsDavid Williams, Patricia Hall, Elizabeth Callaly, Eamon Dolan, Anne HickeyAnne Hickey


Control of vascular risk factors is essential for secondary stroke prevention. However, adherence to secondary prevention medications is often suboptimal, and may be affected by cognitive impairment. Few studies to date have examined associations between cognitive impairment and medication adherence post-stroke, and none have considered whether adherence to secondary prevention medications might affect subsequent cognitive function. The aim of this study was to explore prospective associations between cognitive impairment and medication non-adherence post-stroke.


A five-year follow-up of 108 stroke survivors from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective observational cohort study. Cognitive function was assessed using the Montreal Cognitive Assessment at 6 months, and a neuropsychological test battery at 5 years. Adherence to antihypertensive, antithrombotic and lipid-lowering medications was assessed using prescription refill data.


The prevalence of cognitive impairment at five years was 35.6%. The prevalence of non-adherence ranged from 15.1% for lipid-lowering agents to 30.2% for antithrombotics. There were no statistically significant associations between medication non-adherence in the first year post-stroke and cognitive impairment at 5 years, nor between cognitive impairment at 6 months and non-adherence at 5 years. Stroke survivors with cognitive impairment were significantly more likely to report receiving help with taking medications [OR (95% CI): 4.84 (1.17, 20.07)].


This is the first study to explore the potential impact of non-adherence to secondary prevention medications on cognitive impairment in stroke survivors. Findings highlight the role of family members and caregivers in assisting stroke survivors with medication administration, particularly in the context of deficits in cognitive function. Involving family members and caregivers may be a legitimate and cost-effective strategy to improve medication adherence in stroke survivors.


Health Research Board [grant numbers SPHeRE2013/1, 1404/7400. RL-15-1579. Irish Heart Foundation [grant number 1296829]



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Published Citation

Rohde D, Gaynor E, Large M, Mellon L, Bennett K1, Williams DJ, Brewer L, Hall P, Callaly E, Dolan E, Hickey A. Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort. PLoS One. 2019;14(10):e0223997

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  • Beaumont Hospital
  • Clinical Research Centre
  • Data Science Centre
  • Health Psychology
  • Medicine