Association between cognitive impairment and antiseizure medication adherence among people with epilepsy in Addis Ababa, Ethiopia

Background: Cognitive impairment is one of the most common and most troublesome comorbidities among people with epilepsy (PWE). Adherent use of antiseizure medications (ASM) can control seizure episodes in 70% of the cases. However, the relationship between adherent use of ASMs and cognitive impairment in epilepsy is complex. Objective: To assess the association between adherence to ASMs and cognitive status among PWE. Methods: We performed a cross-sectional observational study with prospective data collection from PWE using translated and content -validated Amharic versions of the Montreal cognitive assessment tool (MOCA-B) and a four -item Morisky Medication Adherence Scale (Morski-4). Ordinal logistic regression analysis was performed to evaluate the potential risk factors for cognitive impairment, including ASM adherence, physical exercise, and level of education. Results: A total of 214 individuals with epilepsy were included in this study; 53.7 % were female, and the mean age was 34 years +/- 12. The mean age at seizure occurrence was 19 years +/- 9. The most common epilepsy type among participants was generalized epilepsy (69 %). The prevalence of poor medication adherence to ASM was 54.2 %. The prevalence of mild cognitive impairment was 65.4 %, and 18.2 % had moderate cognitive impairment, particularly affecting verbal fluency (60.8 %) and memory (43.9 %). Cognitive impairment was significantly associated with poor ASM adherence (AOR = 12.0, 95 %CI, (1.53, 93.75), lower level of physical exercise (AOR = 16.30, 95 %CI (1.24, 214.99), and poor educational attainment with both no formal education (AOR = 0.04, 95 %CI (0.02, 0.14)) and primary or secondary level education (AOR = 0.32, 95 %CI, (0.15, 0.70). Conclusions: There is a high rate of cognitive impairment and non -adherence to ASMs in PWE living in Addis Ababa, Ethiopia. Poor ASM adherence is a possible risk factor for cognitive impairment. PWE can benefit from interventions to improve ASM adherence, physical exercise, and better educational attainment.