Polypharmacy in patients with Multiple Sclerosis: effects on fatigue, perceived cognition, and objective cognitive performance
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OBJECTIVE: Many individuals with multiple sclerosis (MS) take multiple medications on a regular basis, also referred to as polypharmacy. In other patient populations, polypharmacy has been associated with fatigue and cognitive dysfunction. However, no study has examined polypharmacy in MS. We explored the association between polypharmacy, fatigue, and cognition in a group of participants with MS. METHODS: Data for this study were collected as part of a larger investigation examining medication adherence in MS. The sample included 86 patients with MS and 20 healthy controls. We assessed objective cognitive functioning, self-reported cognition, and self-reported fatigue. In addition, a list of patients' medications was obtained at the time of testing. Polypharmacy was classified using a cutoff of 5 or more daily medications. RESULTS: Approximately 33% of the MS sample had polypharmacy. After controlling for age, disease duration, and disability, MS patients with polypharmacy reported more memory problems, processing speed difficulties, and fatigue than MS patients without polypharmacy, F(1, 79) = 13.09, p = .001 and F(1, 79) = 7.33, p < .01, F(1, 79) = 10.45, p < .01, respectively. MS patients with polypharmacy also exhibited worse prospective memory performance than patients without polypharmacy, F(1, 77) = 12.67, p = .001. CONCLUSIONS: This is the first study to examine the association between fatigue, cognition, and polypharmacy in MS patients. Results suggest that researchers should account for polypharmacy and medication effects when conducting studies examining fatigue and cognition in MS. Similarly, clinicians and patients should carefully weigh the costs and benefits of prescribing multiple medications, as these may contribute to iatrogenic fatigue and cognitive problems.
Table of Contents
Overview -- Review of literature -- Method -- Results -- Discussion -- Appendix