Stroke survivors over-estimate their medication self-administration (MSA) ability, predicting memory loss

Abstract

Background and objective: Medication self-administration (MSA) may be cognitively challenging after stroke, but guidelines are currently lacking for identifying high-functioning stroke survivors who may have difficulty with this task. Complicating this matter, stroke survivors may not be aware of their cognitive problems (cognitive anosognosia) and may over-estimate their MSA competence. The authors wished to evaluate medication self-administration and MSA self-awareness in 24 consecutive acute stroke survivors undergoing inpatient rehabilitation, to determine if they would over-estimate their medication self-administration and if this predicted memory disorder.

Methods: Stroke survivors were tested on the Hopkins Medication Schedule and also their memory, naming mood and dexterity were evaluated, comparing their performance to 17 matched controls.

Results: The anosognosia ratio indicated MSA over-estimation in stroke survivors compared with controls—no other over-estimation errors were noted relative to controls. A strong correlation was observed between over-estimation of MSA ability and verbal memory deficit, suggesting that formally assessing MSA and MSA self-awareness may help detect cognitive deficits.

Conclusions: Assessing medication self-administration and MSA self-awareness may be useful in rehabilitation and successful community-return after stroke.

• Anosognosia
• memory
• patient safety
• rehabilitation
• stroke

Acknowledgements

We thank the stroke survivors who took part in this study, Alexander Kong, for helping us with final data and manuscript preparation, and Siby Varughese, MA, RN, for research co-ordination of the experiment, work on its data collection and management and participant data auditing. Reviewers gave us valuable feedback on a preliminary version of the manuscript and helped us greatly improve the presentation. The work was presented in preliminary form at the 2008 annual meeting of the American Association of Academic Physiatrists, American Journal of Physical Medicine and Rehabilitation 87 (Suppl 3): S25.2008. Our work was funded by the Kessler Foundation and the National Institutes of Health (Barrett, PI: K24HD062647).

Declartaion of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article