2024 American Academy of Neurology Abstract Website

Objective:

This study was aimed to explore the relationship between epilepsy characteristics and cognitive impairment in the older epilepsy patients.

Background:

There has been emerging evidence implying the bidirectional relationship between epilepsy and dementia. However, there is limited evidence investigating the association between epilepsy characteristics and cognitive function in elderly population with epilepsy.

Design/Methods:

Patients aged ≥ 55 years without known diagnosis of neurocognitive disorder were analyzed from the Geriatric Epilepsy Clinic over two years from 2019 to 2021. Alzheimer’s Disease – 8 (AD8) and Rapid Cognitive Screen (RCS) were used as subjective and objective screening tools for cognitive impairment respectively. AD8 score ≥ 2 and RCS score ≤ 7 were considered as positive. Logistic regression analyses were performed.

Results:

In a total of 56 older patients with epilepsy (mean age 63.95 years, female 51.80%, and African Americans 89.30%), 32 patients (57.10%) by AD8 and 36 patients (64.30%) by RCS had cognitive impairment. Among epilepsy characteristics, anti-epileptic drugs (AEDs) polytherapy, regardless of the number of AEDs, (β=2.151, p=0.037) and absence of generalized tonic-clonic seizures (GTCs) or focal to bilateral tonic-clonic seizures (FTBTCs; β=-2.010, p=0.032) showed significant associations with AD8 positivity after consideration of age, gender, education level, and history of anxiety, depression, and psychiatric disorders. Age of epilepsy onset, duration of epilepsy, seizure frequency, or etiology of epilepsy did not have any significant relationship with AD8. RCS positivity was not significantly associated with any epilepsy characteristics.

Conclusions:

AEDs polytherapy and absence of GTCs/ FTBTCs in older epilepsy patients might predict subjective or caregiver-observed cognitive impairment. These results suggest that decreasing AEDs burden in this population needs to be considered in order to preserve cognitive function. Presentation of focal seizure without GTCs/ FTBTCs is sufficient to have cognitive impairment in the older epilepsy patients, who may require vigilant cognitive screening regardless of seizure types.