Association between cognitive impairment and antiseizure medication adherence among people with epilepsy in Addis Ababa, Ethiopia
Abstract
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.
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Mamo et al. emphasized personalized deprescribing for cognitively impaired patients.
“Mamo et al. emphasized personalized deprescribing for cognitively impaired patients [34].”
Mamo et al. [34] linked cognitive dysfunction to poor adherence in epilepsy patients.
“Mamo et al. [34] linked cognitive dysfunction to poor adherence in epilepsy patients.”
Cognitive impairment is a significant risk factor for poor adherence to antiepileptic drugs in epilepsy patients.
“Cognitive impairment is also a significant risk factor for poor adherence to antiepileptic drugs in epilepsy patients [34].”
Cites
The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment
Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2005.53221.x · Cited by 25,553 · see citing works
World Health Organization 2020 guidelines on physical activity and sedentary behaviour
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., Carty, C., Chaput, J.-P., Chastin, S., Chou, R., et al. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102955 · Cited by 11,657 · see citing works
Estimation of the burden of active and life-time epilepsy: a meta-analytic approach
Ngugi, A. K., Bottomley, C., Kleinschmidt, I., Sander, J. W., & Newton, C. R. (2010) · Epilepsia · doi:10.1111/j.1528-1167.2009.02481.x · Cited by 1,447 · see citing works
Comorbidities of epilepsy: current concepts and future perspectives
Keezer, M. R., Sisodiya, S. M., & Sander, J. W. (2016) · The Lancet Neurology · doi:10.1016/s1474-4422(15)00225-2 · Cited by 778 · see citing works
Jia, X., Wang, Z., Huang, F., Su, C., Du, W., Jiang, H., Wang, H., Wang, J., Wang, F., Su, W., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03495-6 · Cited by 731 · see citing works
Jokeit, H., & Ebner, A.-S. (1999) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.67.1.44 · Cited by 314 · see citing works
Cognitive Effects of Antiepileptic Drugs
Park, S.-P., & Kwon, S. (2008) · Journal of Clinical Neurology · doi:10.3988/jcn.2008.4.3.99 · Cited by 275 · see citing works
Cognitive Decline in Severe Intractable Epilepsy
Thompson, P. J., & Duncan, J. S. (2005) · Epilepsia · doi:10.1111/j.1528-1167.2005.00279.x · Cited by 240 · see citing works
Vingerhoets, G. (2006) · Seizure · doi:10.1016/j.seizure.2006.02.012 · Cited by 194 · see citing works
Incidence of Epilepsy in Rural Central Ethiopia
Tekle‐Haimanot, R., Forsgren, L., & Ekstedt, J. (1997) · Epilepsia · doi:10.1111/j.1528-1157.1997.tb01138.x · Cited by 156 · see citing works
A review of medication adherence in people with epilepsy
Malek, N., Heath, C. A., & Greene, J. (2016) · Acta Neurologica Scandinavica · doi:10.1111/ane.12703 · Cited by 155 · see citing works
Can MoCA and MMSE Be Interchangeable Cognitive Screening Tools? A Systematic Review
Siqueira, G. S. A., Hagemann, P. D. M. S., Coelho, D. D. S., Santos, F. H., & Bertolucci, P. H. F. (2018) · The Gerontologist · doi:10.1093/geront/gny126 · Cited by 152 · see citing works
Association of Epilepsy and Comorbid Conditions
Seidenberg, M., Pulsipher, D. T., & Hermann, B. P. (2009) · Future Neurology · doi:10.2217/fnl.09.32 · Cited by 145 · see citing works
AUSTIN, J. K., Dunn, D. W., Johnson, C. S., & Perkins, S. M. (2004) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2004.06.014 · Cited by 137 · see citing works
Mechanisms Responsible for Cognitive Impairment in EpilepsyPreprint
Lenck‐Santini, P., & Scott, R. C. (2015) · Cold Spring Harbor Perspectives in Medicine · doi:10.1101/cshperspect.a022772 · Cited by 120 · see citing works
Identifying the barriers to antiepileptic drug adherence among adults with epilepsy
Rourke, G. O., & Brien, J. J. O. (2016) · Seizure · doi:10.1016/j.seizure.2016.12.006 · Cited by 116 · see citing works
Adherence to antiepilepsy drug therapy
Faught, E. (2012) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2012.08.027 · Cited by 105 · see citing works
Factors for cognitive impairment in adult epileptic patients
Wang, L., Chen, S., Liu, C., Lin, W., & Huang, H. (2019) · Brain and Behavior · doi:10.1002/brb3.1475 · Cited by 92 · see citing works
Epilepsy, antiepileptic drugs (AEDs) and cognition
Hirsch, É., Schmitz, B., & Carreño, M. (2003) · Acta Neurologica Scandinavica · doi:10.1034/j.1600-0404.108.s180.4.x · Cited by 77 · see citing works
Factors related to medication adherence in memory disorder clinic patients
Ownby, R., Hertzog, C. K., Crocco, E., & Duara, R. (2006) · Aging & Mental Health · doi:10.1080/13607860500410011 · Cited by 69 · see citing works
Hasiso, T. Y., & Desse, T. A. (2016) · PLoS ONE · doi:10.1371/journal.pone.0163040 · Cited by 58 · see citing works
Feter, N., Alt, R., Häfele, C. A., da Silva, M. C., & Rombaldi, A. J. (2020) · Epilepsia · doi:10.1111/epi.16588 · Cited by 56 · see citing works
Effects of physical exercise in people with epilepsy: A systematic review and meta-analysis
Duñabeitia, I., Bidaurrazaga‐Letona, I., Diz, J. C., Colon-Leira, S., García-Fresneda, A., & Pérez, C. A. (2022) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2022.108959 · Cited by 56 · see citing works
Role of Physical Activity and Exercise in Alleviating Cognitive Impairment in People With Epilepsy
Allendorfer, J. B., & Arida, R. M. (2017) · Clinical Therapeutics · doi:10.1016/j.clinthera.2017.12.004 · Cited by 55 · see citing works
Belayneh, Z., & Mekuriaw, B. (2020) · Archives of Public Health · doi:10.1186/s13690-020-00405-2 · Cited by 51 · see citing works
Sport and Physical Activity in Epilepsy
van den Bongard, F., Hamer, H. M., Sassen, R., & Reinsberger, C. (2020) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2020.0001 · Cited by 47 · see citing works
Pai, M., & Tsai, J.-J. (2005) · Epilepsia · doi:10.1111/j.0013-9580.2005.461003.x · Cited by 39 · see citing works
Daniel, B., Agenagnew, L., Workicho, A., & Abera, M. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s377430 · Cited by 32 · see citing works
Ibinda, F., Odermatt, P., Kariuki, S. M., Kakooza‐Mwesige, A., Wagner, R. G., Owusu‐Agyei, S., Masanja, H., Ngugi, A. K., Mbuba, C. K., Doku, V. C. K., et al. (2017) · Epilepsia Open · doi:10.1002/epi4.12052 · Cited by 31 · see citing works
Cognitive impairment in epilepsy: State of affairs and clinical relevance
Aldenkamp, A. P. (2006) · Seizure · doi:10.1016/j.seizure.2006.02.010 · Cited by 31 · see citing works
Roheger, M., Xu, H., Hoang, M. T., Eriksdotter, M., & Ptacek, S. G. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.03.018 · Cited by 30 · see citing works
Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study
Dima, S. A., & Shibeshi, M. S. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263821 · Cited by 29 · see citing works
Cognitive Function in Nigerians with Newly Diagnosed Epilepsy
Ogunrin, O. A., Adamolekun, B., Ogunniyi, A. O., & Aldenkamp, A. P. (2000) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100052264 · Cited by 27 · see citing works
Powell, K., Walker, R. W., Rogathe, J., Gray, W. K., Hunter, E., Newton, C. R. J. C., & Burton, K. (2015) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2015.06.034 · Cited by 26 · see citing works
Salpekar, J. A. (2016) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20160017 · Cited by 25 · see citing works
Alexander, H. B., & Allendorfer, J. B. (2023) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2023.109170 · Cited by 24 · see citing works
Fayet, F., Fan, A., Rodère, M., Savel, C., Pereira, B., & Soubrier, M. (2020) · Patient Preference and Adherence · doi:10.2147/ppa.s240179 · Cited by 23 · see citing works
Koirala, G. R., Lee, D., Eom, S., Kim, N., & Kim, H. D. (2017) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2017.06.021 · Cited by 18 · see citing works
Kanazawa, K., Matsumoto, R., Shimotake, A., Kinoshita, M., Otsuka, A., Watanabe, O., Tanaka, K., Takahashi, R., & Ikeda, A. (2014) · Epileptic Disorders · doi:10.1684/epd.2014.0664 · Cited by 16 · see citing works
Popp, J. L., Szaflarski, J. P., Kaur, M., Martin, R. C., Brokamp, G. A., Terry, D. M., Diggs, M. D., & Allendorfer, J. B. (2021) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2021.107900 · Cited by 15 · see citing works
Abdeta, C., Seyoum, B., & Teklemariam, Z. (2019) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2018-000463 · Cited by 13 · see citing works
Comparison of screening tests in the evaluation of cognitive status of patients with epilepsy
de Souza, M. C., de Paulo, C. O., Miyashiro, L., & Twardowschy, C. A. (2021) · Dementia & Neuropsychologia · doi:10.1590/1980-57642021dn15-010016 · Cited by 12 · see citing works
Abdeta, C., Teklemariam, Z., & Seyoum, B. (2018) · Baltic Journal of Health and Physical Activity · doi:10.29359/bjhpa.10.2.08 · Cited by 11 · see citing works
Prevalence of Cognitive Adverse Outcomes in Epileptic Outpatients
Merkena, M. D. (2016) · Journal of Neurology & Stroke · doi:10.15406/jnsk.2016.04.00155 · Cited by 9 · see citing works
Asnakew, S., Legas, G., Belete, A., Admasu, F. T., Yitbarek, G. Y., Aytenew, T. M., Demise, B., Alemu, E. M., Alemu, M. A., Bayih, W. A., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0278908 · Cited by 8 · see citing works
Arinzechi, E. O., Ogunrin, O. A., Nwosu, C. M., Nwani, P., Enwereji, K. O., Asomugha, L. A., & Dimkpa, U. (2016) · Journal of Neurosciences in Rural Practice · doi:10.4103/0976-3147.181488 · Cited by 8 · see citing works
Lestari, N. D., Rizkidawati, R., Shafira, C. P., Suherman, S., & Mutiawati, E. (2020) · Bali Medical Journal · doi:10.15562/bmj.v9i1.1736 · Cited by 7 · see citing works
Papaliagkas, V. T., Lokantidou-Argyraki, C., Patrikelis, P., Zafeiridou, G., Spilioti, M. G., Afrantou, T., Kosmidis, M. H., Arnaoutoglou, M., & Kimiskidis, V. Κ. (2023) · Diagnostics · doi:10.3390/diagnostics13182875 · Cited by 7 · see citing works
Malik, M., Khan, M. U., Hussain, A., & Hashmi, A. (2019) · Archives of Psychiatry and Mental Health · doi:10.29328/journal.apmh.1001006 · Cited by 6 · see citing works
Wazema, D. H., Assefa, Z. M., Shiferaw, B. Z., Geleta, O. T., & Haile, T. G. (2023) · SAGE Open Nursing · doi:10.1177/23779608231154400 · Cited by 3 · see citing works
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Balabandian, M., Manavi, M. A., Lesani, A., Jafari, R. M., Shafaroodi, H., Heidari, N., Mirnajafi‐Zadeh, J., Foroumadi, A., Afrooghe, A., & Dehpour, A. R. (2025) · Pharmacology Research & Perspectives · doi:10.1002/prp2.70079 · Cited by 7 · see citing works
Mehany, O., Artner, A., Sebők, S., Hankó, B., & Zelkó, R. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15052069 · Cited by 6 · see citing works
Jannah, A. H., Devianca, N., Andrajati, R., Octaviana, F., Wiratman, W., Indrawati, L. A., Harsono, A. R., Hakim, M., Safri, A. Y., Fadli, N., et al. (2026) · Acta Epileptologica · doi:10.1186/s42494-025-00237-z · Cited by 2 · see citing works
Turan, G. B., & Demir, M. (2026) · Brain and Behavior · doi:10.1002/brb3.71550 · Cited by 2 · see citing works
Neuropsychological assessment for epileptic disease: From theory to practice
Zhang, L., Pan, X., & Yu, Q. (2025) · Applied Neuropsychology Adult · doi:10.1080/23279095.2025.2544821 · Cited by 1 · see citing works
Oyugi, J., Izudi, J., & Bajunirwe, F. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06057-7 · Cited by 1 · see citing works
- Authors
- Mamo, B., Feyissa, A. M., Mengesha, T., Ayele, B. A., & Mamushet Yifru, Y.
- Affiliations
- Addis Ababa University (ET)
- Mayo Clinic (US)
- University of California, San Francisco (US)
- Corresponding author
- Mamo, Blen
- Feyissa, Anteneh M.
- Mengesha, Tariku
- Ayele, Biniyam A.
- Venue
- Epilepsy & Behavior
- Publisher
- Elsevier BV
- Published
- 2024-03
- Volume
- 152
- Pages
- 109651
- ISSN
- 1525-5050 (ISSN-L)
- OpenAlex
- W4391418480
- Cited by
- 6
- References
- 50
- Citations by year
- 2026: 3 · 2025: 3
- FWCI
- 1.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Epilepsy & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Addis Ababa University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- cognitive impairment, epilepsy, medication non-adherence, mild cognitive impairment, physical activity, educational attainment, verbal fluency, memory, Addis Ababa
- MeSH terms
- Adult, Cross-Sectional Studies, Epilepsy, Ethiopia, Female, Humans, Male, Seizures, Medication Adherence, Young Adult, Cognitive Dysfunction
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