To assess the prevalence and structure of non-adherence in Russian population of patients with advanced atherosclerosis.

Sixty patients (mean age was 69±11 yrs, 30 males) with advanced cerebral arteriosclerosis and ischemic heart disease were randomly selected from cardiovascular department and enrolled in the study for subsequent psychiatric counseling, questionnaires and MRI procedures. Patients with stoke, focal neurological deficit and any psychiatric disorders in anamnesis were excluded.

We have shown that 80% of patients have decreased or completely absent adherence to medical care. This patients were subsequently divided into three subgroups. First subgroup (30%) was characterized by partial denial of illness, where 3 (5%) patients suggest that they understanding somatic disease clinical course better than doctors. Significantly decreased compliance was most apparent in secound subgroup (30%), manifesting in self-changing drug and dosage regimen (for instance, skipping the medication without the doctor advise. In this subgroup 6 patients (10%) showed denial of treatment pattern underscored that conventional treatment for atherosclerosis as a whole is harmful for them and prefer to avoid all medications after discharge. Third subgroup included patients with vascular dementia (20%), where MRI analysis revealed white matter lesions with preferable localisation in emotional areas of cerebral (sub)cortex. There was a strong and significant correlation between the MRI white matter leasions score and treatment non-adherence level (r = 0.75).

Non-adherence is very prevalent in patients with advanced atherosclerosis estimating for up to 80%, while severe non-adherence is observed in 35% of patients.