The role of prospective memory in medication adherence: a review of an emerging literature.

Although neurocognitive impairment is an established risk factor for medication nonadherence, standard neurocognitive tests developed for clinical purposes may not fully capture the complexities of non-adherence behavior or effectively inform theory-driven interventions. Prospective memory, an innovative cognitive construct describing one's ability to remember to do something at a later time, is an understudied factor in the detection and remediation of medication non-adherence. This review orients researchers to the construct of prospective memory, summarizes empirical evidence for prospective memory as a risk factor for non-adherence, discusses the relative merits of current measurement techniques, and highlights potential prospective memory-focused intervention strategies. A comprehensive literature review was conducted of published empirical studies investigating prospective memory and medication adherence. Overall, reviewed studies suggest that prospective memory is an important component of medication adherence, providing incremental ecological validity over established predictors. Findings indicate that prospective memory-based interventions might be an effective means of improving adherence.

Are time- and event-based prospective memory comparably affected in HIV infection?

According to the multi-process theory of prospective memory (ProM), time-based tasks rely more heavily on strategic processes dependent on prefrontal systems than do event-based tasks. Given the prominent frontostriatal pathophysiology of HIV infection, one would expect HIV-infected individuals to demonstrate greater deficits in time-based versus event-based ProM. However, the two prior studies examining this question have produced variable results. We evaluated this hypothesis in 143 individuals with HIV infection and 43 demographically similar seronegative adults (HIV-) who completed the research version of the Memory for Intentions Screening Test, which yields parallel subscales of time- and event-based ProM. Results showed main effects of HIV serostatus and cue type, but no interaction between serostatus and cue. Planned pair-wise comparisons showed a significant effect of HIV on time-based ProM and a trend-level effect on event-based ProM that was driven primarily by the subset of participants with HIV-associated neurocognitive disorders. Nevertheless, time-based ProM was more strongly correlated with measures of executive functions, attention/working memory, and verbal fluency in HIV-infected persons. Although HIV-associated deficits in time- and event-based ProM appear to be of comparable severity, the cognitive architecture of time-based ProM may be more strongly influenced by strategic monitoring and retrieval processes.

HIV-associated prospective memory impairment in the laboratory predicts failures on a semi-naturalistic measure of health care compliance.

HIV-associated neurocognitive impairment, particularly in the domain of prospective memory (ProM), increases the risk of poor everyday functioning outcomes, including medication non-adherence. However, whether ProM plays a role in health care compliance outside of the realm of medication adherence remains to be determined. This study evaluated the hypothesis that ProM is an independent predictor of failure to comply with non-medication-related instructions akin to those commonly given by health care providers. Participants were 139 HIV-infected adults who underwent medical, psychiatric, and neuropsychological assessments, including a laboratory-based measure of ProM. To assess real-world compliance, participants were instructed to call the examiner 24 hours after the evaluation and report how many hours they had slept. Individuals who failed to correctly comply with these instructions (n = 104) demonstrated significantly lower performance on both time- and event-based ProM at baseline than the compliant group (n = 35), an effect that was primarily driven by errors of omission. ProM remained a significant predictor of noncompliance after controlling for potential confounders, including demographics (e.g., education), traditional cognitive measures of retrospective memory and executive functions, and psychiatric factors (e.g., depression). Results support the hypothesis that ProM plays a unique role in compliance with health care instructions for HIV disease management and may inform interventions designed to improve treatment outcomes.

Using social networks to recruit an HIV vaccine preparedness cohort.

OBJECTIVES: To evaluate a social network approach to develop an adolescent cohort for HIV vaccine preparedness and investigate characteristics that influence recruitment. METHODS: We summarize baseline data from a prospective cohort study that included 4 sessions over 6 months. Fifty-nine HIV-infected adolescent and adult patients of a family-based HIV clinic named significant others and indicated willingness to involve them in this study. Sixty-two adolescent and adult significant others not known to be HIV infected were enrolled. Logistic regression was used to estimate factors associated with willingness. RESULTS: Participants identified 624 social network members including 276 adolescents (44%). Network member's awareness of the index's HIV positivity (P < 0.01) and older age (P = 0.05) affected willingness. Respondents were less willing to invite drug-risk alters (P = 0.006). Adolescents were willing to invite more adolescents than were adults (P < 0.0001). Adolescents younger than 18 years old reported fewer sexual and drug-using risk behaviors than expected. CONCLUSIONS: HIV-infected patients are willing to recruit their social networks, provided concerns about disclosure of HIV status are addressed. Using social networks to identify and recruit adolescent populations is appropriate and feasible for vaccine preparedness activities, future vaccine trials, and other prevention programs, but procedures are needed to selectively identify and retain high-risk youth.

Spontaneous cognition and HIV risk behavior.

Theories of cognitive processes and risk behavior have not usually addressed spontaneous forms of cognition that may co-occur with, or possibly influence, behavior. This study evaluated whether measures of spontaneous cognition independently predict HIV risk behavior tendencies. Whereas a trait-centered theory suggests that spontaneous cognitions are a by-product of personality, a cognitive view hypothesizes that spontaneous cognitions should predict behavior independently of personality. The results revealed that spontaneous cognition was an independent predictor of behavior tendencies in cross-sectional analyses. Its predictive effect was stronger than drug use, a frequently emphasized correlate of HIV risk behavior in the literature, and comparable with sensation seeking in magnitude. The results suggested that a relatively spontaneous form of cognition may affect HIV risk behavior.

Exposure to televised alcohol ads and subsequent adolescent alcohol use.

OBJECTIVE: To assess the impact of televised alcohol commercials on adolescents' alcohol use. METHODS: Adolescents completed questionnaires about alcohol commercials and alcohol use in a prospective study. RESULTS: A one standard deviation increase in viewing television programs containing alcohol commercials in seventh grade was associated with an excess risk of beer use (44%), wine/liquor use (34%), and 3-drink episodes (26%) in eighth grade. The strength of associations varied across exposure measures and was most consistent for beer. CONCLUSIONS: Although replication is warranted, results showed that exposure was associated with an increased risk of subsequent beer consumption and possibly other consumption variables.

Self-generated alcohol outcomes in 8th and 10th graders: exposure to vicarious sources of alcohol information.

The perceived positive and negative outcomes of alcohol use were studied in a sample of normal 8th and 10th grade students. Participants' responses provided associative frequency norms valuable for future research. Regression analyses showed (1) none of the individual-difference variables (alcohol use, exposure to vicarious sources of alcohol information, such as televised advertising, and demographics) predicted self-generated responses, and (2) alcohol use and first-hand observation of others' drinking did predict the valence respondents assigned to the outcomes. Results support and extend the findings of Stacy, Galaif, Sussman, and Dent [Psychology of Addictive Behaviors 10(1) 1996 18], wherein self-generated drug use outcomes appeared to be available in memory regardless of previous drug use or other individual differences.