Summary:Purpose: Reliable change indices (RCIs) and standardized regression-based (SRB) change scores norms were established for the recently revised Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III) in patients with complex partial seizures. Establishment of such standardized change scores can be useful in determining the effects of epilepsy surgery on cognitive functioning independent of test-retest artifacts including practice effects.Methods: Forty-two nonoperated-on adult patients with complex partial seizures (primarily of temporal lobe onset) were administered the WMS-III and WAIS-III on two occasions (mean 7-month interval). All patients were receiving stable antiepileptic drug (AED) treatment at both testings. RCI and SRB change scores were calculated. Confidence interval cutoff scores (90% and 80%) and standardized regression equations were calculated for each of the WAIS-III and WMS-III Primary Indices and individual subtests. Age, gender, education, testretest interval, preoperative test performance, seizure onset, and seizure duration were predictor variables for the SRB equations.Results: Test-retest reliabilities for the WAIS-III and WMS-III Primary Indices were within acceptable ranges, although considerable individual subtest variability was found. Preoperative performance was the single largest contributor to each of the predictive regression equations. Age, gender, education, seizure onset, and seizure duration contributed modest variance to several of the regression equations.Conclusions: We calculated both RCI and SRB change score indices for the recently revised Wechsler instruments. These formulas help control for test-retest methodologic artifacts and provide a standardized method with which to examine both individual and group level cognitive change after epilepsy surgery.

Summary:Purpose: To examine cognitive functioning in community-dwelling older adults with chronic partial epilepsy and demographically matched healthy older adults.Methods: Standardized measures of neurocognitive function were collected as part of an ongoing study investigating healthrelated quality-of-life issues in older adults with epilepsy. Cognitive tests consisted of the Mattis Dementia Rating Scale (subscales include attention, initiation/perseveration, construction, conceptualization, memory), Logical Memory subtest from the WMS-III (immediate and delayed recall scores), and word fluency. Mood was measured with the Geriatric Depression Scale. Older adults with epilepsy (n = 25) and healthy older adults (n = 27) completed testing. All participants were at least 60 years old, living independently in the community, and had no history of drug/alcohol abuse or life-threatening medical conditions. All older adults with epilepsy had been diagnosed as having medically intractable partial complex seizures, including those with histories of secondary generalization. Results:Older adults with epilepsy demonstrated impairments across all cognitive measures compared with the healthy controls. Seizure onset (age) and seizure duration (years) were not statistically associated with neurocognitive function or selfreported mood. Older adults with epilepsy who were receiving antiepileptic drug (AED) polytherapy (n = 11) displayed worse performance on the attention, initiation/perseveration, and memory subscales of the DRS and Logical Memory delayed recall score compared with those older adults with epilepsy receiving monotherapy (n = 14). The number of AEDs taken was not associated with seizure frequency.Conclusions: Negative effects on cognitive function are experienced by older adults with chronic partial epilepsy. AED polytherapy may increase the risk for negative cognitive dysfunction. Key Words: Older adults-Partial epilepsyCognition-Mood-Antiepileptic medication.The prevalence of epilepsy in older adults and the aging of our society provides a mandate for epilepsy researchers to examine this understudied group. In a widely cited study, Hauser and colleagues (1) demonstrated that epilepsy has a peak incidence in early childhood, with a second peak occurring for those aged 60 years and older. Some persons have experienced life-long epilepsy and survive past their sixth decade, representing a distinct but perhaps higher at-risk group for many complications of living with epilepsy (2-5).Only recently have researchers turned their attention to the study of older adults with epilepsy (6,7). (9) reported on the lack of a deleterious cognitive effect with changes in antiepileptic monotherapy in older patients with epilepsy, but made no statements regarding the overall cognitive performance of their patients compared with that of healthy older adults. One recent randomized double-blinded crossover design study of healthy community-dwelling older volunteers reported mild negative cognitive and behavioral effects of carbamazep...

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