The Impact of Cognition on Treatment Adherence in Comorbid Bipolar Disorder and Cocaine Dependence

Although bipolar disorder and substance dependence are associated with treatment nonadherence and cognitive impairment, few studies have investigated the relationship between treatment adherence and cognitive functioning. Participants in this study were 120 outpatients with bipolar disorder and cocaine dependence enrolled in a 10 week randomized, double-blind, placebo controlled trial of lamotrigine. Baseline performance on the Stroop Color and Word Test and the Rey Auditory Verbal Learning Test were examined for their effect on retention, appointment attendance, medication adherence, and return of medication bottles. Participants with decreased scores on Word condition of the Stroop Color and Word Test were more likely and those with decreased Interference scores were as likely to attend appointments. Participants with better Rey Auditory Verbal Learning Test Total Recall scores returned more medication bottles. Cognitive functioning did not impact medication adherence or study retention. The findings suggest a relationship between cognitive functioning and treatment attendance. Assessment and treatment of cognitive dysfunction may identify and help patients at-risk for treatment nonadherence. Future studies with a more comprehensive neuropsychological test battery and advanced medication adherence measures are warranted.