In older adults with asthma, cognitive impairment is not associated with asthma symptom perception, according to study results published in the Journal of Asthma. In these individuals, the perception of symptoms is neither a mediator nor a moderator of the association between cognitive ability and asthma medication adherence.

In a longitudinal cohort study, investigators sought to examine the relationship between cognitive functioning, asthma symptom perception, and asthma self-management in a group of older adults with asthma by initially testing the theory that poor performance would be related to low medication adherence.

The researchers then explored whether underperception of asthma symptoms would be associated with poor performance on measures of general cognitive functioning. Finally, they evaluated whether underperception of asthma symptoms might mediate the link between poor performance on measures of general cognitive functioning and nonadherence to medication.

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All data were collected cross-sectionally during baseline visits between January 2017 and January 2020. At the baseline session, formally trained research assistants administered cognitive measure. Self-reported medication adherence, demographic information, and other questionnaires that evaluated asthma control (eg, the Asthma Control Questionnaire, Juniper Asthma Quality of Life Questionnaire) and depression (Geriatric Depression Scale) were obtained at this visit as well.

A total of 334 participants who were at least 60 years of age with persistent or severe asthma were enrolled in the study. Mean participant age was 67.9 years; 51.2% of participants were Hispanic, 24.9% were Black, and 84.4% were women.

The cognitive measures assessed included general cognition, attention, processing speed, executive functioning, language, and memory. Measures of asthma self-management were self-reported, with adherence to controller medications being electronically measured. Underperception of asthma symptoms was evaluated by the participants for 6 weeks by entering estimates of their peak expiratory flow into a programmable peak flow meter.

Results demonstrated that self-reported nonadherence to medication was significantly associated with impairment in several domains, including general cognitive functioning (odds ratio [OR], 0.91; 95% CI, 0.86-0.96; P <.001), memory (OR, 0.96; 95% CI, 0.94-0.98; P =.001), attention/processing speed (OR, 1.02; 95% CI, 1.00-1.04; P =.03), and working memory (OR, 0.98; 95% CI, 0.95-0.99; P =.04).

Per adjusted analyses, patients with impairments in general cognitive functioning and memory had lower ORs for self-reported nonadherence and memory (OR, 0.90; 95% CI, 0.83-0.96; P =.002 and OR, 0.96; 95% CI, 0.93-0.98; P =.005, respectively). Cognitive impairment, however, was not associated with electronically measured nonadherence or asthma symptom underperception.

Additionally, structural equation modeling demonstrated that although cognitive impairment was significantly associated with adherence (P =.04), the underperception of asthma symptoms did not mediate this relationship.

Study limitations included those inherent to self-report measures, the potential that objective measures did not adequately capture participant adherence, a lack of data collection between medical appointments, and a lack of generalizability to even older adults with more cognitive impairment.

Investigators concluded that additional research on these relationships is warranted to understand the role played by confounding factors in these analyses.


Becker JH, Feldman JM, Arora A, Busse PJ, Wisnivesky JP, Federman AD. Cognition, symptom perception, and medication non-adherence in older adults with asthma. Published online November 28, 2020. J Asthma. doi:10.1080/02770903.2020.1856867