Journal
CANCER PREVENTION RESEARCH
Volume 7, Issue 1, Pages 161-168Publisher
AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1940-6207.CAPR-13-0165
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Funding
- Public Health Service grants from the National Cancer Institute, NIH [U10-CA-37377, U10-CA-69974, U10CA-12027, U10CA-69651]
- Department of Health and Human Services
- AstraZeneca Pharmaceuticals
- Eli Lilly and Co
- National Institute on Aging [NO1-AG-2106]
- Intramural Research Program, NIA, NIH
- NIA, NIH
- Wake Forest University Claude D. Pepper Older Americans Independence Center [P30 AG-021332]
- Atlantic Philanthropies
- American Society of Hematology
- John A. Hartford Foundation
- Association of Specialty Professors
- Paul Beeson Career Development Award in Aging Research [K23AG038361]
- NIA
- AFAR
- Gabrielle's Angel Foundation for Cancer Research
- NATIONAL CANCER INSTITUTE [U10CA037377, U10CA012027, U10CA069974, U10CA069651] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON AGING [K23AG038361, N01AG002106, P30AG021332] Funding Source: NIH RePORTER
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Little is known about the cognitive factors associated with adherence to antiestrogen therapy. Our objective was to investigate the association between domain-specific cognitive function and adherence among women in a clinical prevention trial of oral antiestrogen therapies. We performed a secondary analysis of Co-STAR, an ancillary study of the STAR breast cancer prevention trial in which postmenopausal women at increased breast cancer risk were randomized to tamoxifen or raloxifene. Co-STAR enrolled nondemented participants >= 65 years old to compare treatment effects on cognition. The cognitive battery assessed global cognitive function (Modified Mini-Mental State Exam), and specific cognitive domains of verbal knowledge, verbal fluency, figural memory, verbal memory, attention and working memory, spatial ability, and fine motor speed. Adherence was defined by a ratio of actual time taking therapy per protocol >= 80% of expected time. Logistic regression was used to evaluate the association between cognitive test scores and adherence to therapy. The mean age of the 1,331 Co-STAR participants was 67.2 +/- 4.3 years. Mean 3MS score was 95.1 (4.7) and 14% were nonadherent. In adjusted analyses, the odds of nonadherence were lower for those with better scores on verbal memory [OR (95% confidence interval): 0.75 (0.62-0.92)]. Larger relative deficits in verbal memory compared with verbal fluency were also associated with nonadherence [1.28 (1.08-1.51)]. Among nondemented older women, subtle differences in memory performance were associated with medication adherence. Differential performance across cognitive domains may help identify persons at greater risk for poor adherence.
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