Difficulty with taking medications and the future risk of Alzheimer's disease and related dementias: Health and Retirement Study of Americans

Abstract

BACKGROUND: This study aims to determine if self-reported issues with managing medication could be an early sign of cognitive decline, possibly pointing to a future diagnosis of Alzheimer's Disease and Related Dementias (ADRD). There is currently very little information available about the link between issues with medication management and the later diagnosis of an ADRD, despite the potential clinical importance of such a link. METHODS: We analyzed Health and Retirement Study participants present and interviewed at Wave 11 (2012) and followed them through Wave 16 (2020). Medication-taking difficulty (R11MEDS) was classified as no difficulty/don't do vs. difficulty/can't do. Separate cohorts excluded prevalent dementia (R11DEMENE) or AD (R11ALZHEE). Incident outcomes were first respondent-reported physician diagnoses (RwDEMENE, RwALZHEE). Kaplan-Meier curves and multivariable Cox models estimated associations. RESULTS: Of 18,878 dementia-free and 19,348 AD-free HRS respondents at Wave 11, 3.0-3.9 reported difficulty/could not take medications. Kaplan-Meier curves diverged early between exposure groups. In fully adjusted Cox models, medication-taking difficulty predicted higher hazards of incident all-cause dementia (HR 1.59, 95 CI 1.23-2.06) and AD (HR 1.57, 95 CI 1.09-2.27), with corroborating pooled logistic estimates. CONCLUSION: Difficulty in Managing Medications is considered to be a robust prodromal indicator of ADRD, regardless of demographic influences. Therefore, the evaluation of an individual's ability to manage medications within routine assessment may represent a practical, costeffective means to identify cognitive decline and develop appropriate management strategies.