Forgotten Prescriptions: A Single Case Study on Medication Non-Adherence and Cognitive Decline

Hypertension remains one of the leading causes of cardiovascular and cerebrovascular morbidity and mortality worldwide. Medication non-adherence and dependence on alternative remedies continue to contribute to poor health outcomes, particularly among adults with chronic illnesses. This case study explored the progression of uncontrolled hypertension in a 48-year-old male storekeeper who gradually discontinued prescribed antihypertensive medication in favor of herbal tea and gel capsules believed to reduce blood pressure. Despite initial medical advice to maintain Amlodipine 10 mg daily following a blood pressure reading of 140/100 mmHg in 2019, the patient eventually stopped regular consultation and relied heavily on herbal alternatives during and after the COVID-19 pandemic. Over time, the patient developed cognitive and behavioral changes suggestive of vascular-related cognitive decline, including memory impairment, disorientation, hallucinations, poor judgment, and functional deterioration. Family members reported increasing resistance to medical consultation and inconsistent medication adherence. In 2024, the patient experienced cardiac arrest and subsequently died after hospitalization. This case highlights the possible consequences of prolonged uncontrolled hypertension, poor treatment adherence, health misinformation, and delayed healthcare consultation. The study supports national and regional health priorities on non-communicable diseases, health literacy, chronic disease management, and preventive healthcare interventions.

Hypertension, medication non-adherence, herbal medicine, vascular dementia, cognitive decline

1. Campbell, N. L., Boustani, M. A., Skopelja, E. N., Gao, S., Unverzagt, F. W., & Murray, M. D. (2012). Medication adherence in older adults with cognitive impairment: A systematic evidence-based review. American Journal of Geriatric Pharmacotherapy, 10(3), 165–177. https://doi.org/10.1016/j.amjopharm.2012.04.004 [Google Scholar] [Crossref]

2. Conn, V. S., Ruppar, T. M., Enriquez, M., & Cooper, P. S. (2015). Medication adherence interventions that target subjects with adherence problems: Systematic review and meta-analysis. Research in Social and Administrative Pharmacy, 12(2), 218–246. https://doi.org/10.1016/j.sapharm.2015.06.001 [Google Scholar] [Crossref]

3. Insel, K., Morrow, D., Brewer, B., & Figueredo, A. (2006). Executive function, working memory, and medication adherence among older adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(2), P102–P107. https://doi.org/10.1093/geronb/61.2.P102 [Google Scholar] [Crossref]

4. Jimmy, B., & Jose, J. (2011). Patient medication adherence: Measures in daily practice. Oman Medical Journal, 26(3), 155–159. https://doi.org/10.5001/omj.2011.38Kini, V., & Ho, P. M. (2018). Interventions to improve medication adherence: A review. JAMA, 320(23), 2461–2473. https://doi.org/10.1001/jama.2018.19271 [Google Scholar] [Crossref]

5. Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly patients. Expert Opinion on Drug Safety, 13(1), 57–65. https://doi.org/10.1517/14740338.2013.827660 [Google Scholar] [Crossref]

6. Petersen, R. C., Lopez, O., Armstrong, M. J., Getchius, T. S., Ganguli, M., Gloss, D., Gronseth, G. S., Marson, D., Pringsheim, T., Day, G. S., Sager, M., Stevens, J., & Rae-Grant, A. (2018). Practice guideline update summary: Mild cognitive impairment. Neurology, 90(3), 126–135. https://doi.org/10.1212/WNL.0000000000004826 [Google Scholar] [Crossref]

7. Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J. (2017). A systematic review of medication non-adherence in persons with dementia or cognitive impairment. PLoS ONE, 12(2), e0170651. https://doi.org/10.1371/journal.pone.0170651 [Google Scholar] [Crossref]

8. Wimmer, B. C., Cross, A. J., Jokanovic, N., Wiese, M. D., George, J., Johnell, K., Diug, B., & Bell, J. S. (2017). Clinical outcomes associated with medication regimen complexity in older people. Journal of the American Geriatrics Society, 65(4), 747–753. https://doi.org/10.1111/jgs.14682 [Google Scholar] [Crossref]

9. World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization. [Google Scholar] [Crossref]

• Migrant Health in Morocco: Between Law and Reality
• CaknaMinda: An Educator-Centred Mobile App for Early Screening of Mental Health and Schizophrenia Risks
• Health System and Nursing Strategies for Enhancing Male Participation in Family Planning: Evidence from Tema General Hospital, Ghana.
• From Īśvara-Praṇidhāna to Parā-Bhakti: Convergent Paths of Aṣṭāṅga Yoga and Bhakti Yoga
• Evidence-Based Psycho-Oncological Interventions: A Multimodal Approach to Supportive Care