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Biological Research For Nursing
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White Matter Hyperintensities and Medication Adherence

Kathleen C. Insel, PhD, RN

College of Nursing, University of Arizona, Tucson, insel{at}nursing.arizona.edu

Sheryl L. Reminger, PhD

Department of Psychology, University of Illinois, Springfield

Chao-Pin Hsiao, MS, RN

College of Nursing, University of Arizona, Tucson

White matter hyperintensities (WMH) are associated with hypertension, age, and cognitive function, but the association between WMH and medication adherence has not been examined. The intent of this investigation was to consider the potential implications of hypertension-related brain morphological changes on medication adherence and thereby improve understanding of the self-management consequences of hypertension. The associations between WMH, blood pressure, age, cognitive function (specifically assessments of prefrontal function), and medication adherence were examined in 16 middle-aged and older adults self-managing at least one prescribed antihypertensive agent. Magnetic resonance imaging using an axial fluid attenuated inversion recovery (FLAIR) sequence was used to assess the presence of WMH. Cognitive assessments included measures of executive function, working memory, attention, and immediate recall. Adherence was monitored for 8 weeks using electronic medication monitoring. More WMH were associated with poorer adherence (rs = —.25) and with higher systolic blood pressure (rs = .46), although these relationships were not statistically significant. WMH were associated with cognitive assessments in the expected direction including Digit Span Backward (rs = —.53, p < .05). Adherence was associated with immediate memory (rs = .54, p < .05) and inversely associated with failure to maintain set on the Wisconsin Card Sorting Test (WCST; r s = —.61, p < .05). These findings provide preliminary evidence for the association between WMH, assessments of prefrontal function, and medication adherence.

Key Words: white matter hyperintensities (WMH) • MRI • medication adherence • hypertension • cognitive • executive function

Biological Research For Nursing, Vol. 10, No. 2, 121-127 (2008)
DOI: 10.1177/1099800408322216
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