Association of Neighborhood Deprivation With Cognitive and Mood Outcomes in Adults With Pharmacoresistant Temporal Lobe Epilepsy

Abstract

Background and ObjectivesTemporal lobe epilepsy (TLE) is the most common adult form of epilepsy and is associated with a high risk of cognitive deficits and depressed mood. However, little is known about the role of environmental factors on cognition and mood in TLE. This cross-sectional study examined the relationship between neighborhood deprivation and neuropsychological function in adults with TLE.MethodsNeuropsychological data were obtained from a clinical registry of patients with TLE and included measures of intelligence, attention, processing speed, language, executive function, visuospatial skills, verbal/visual memory, depression, and anxiety. Home addresses were used to calculate the Area Deprivation Index (ADI) for each individual, which were separated into quintiles (i.e., quintile 1 = least disadvantaged and quintile 5 = most disadvantaged). Kruskal-Wallis tests compared quintile groups on cognitive domain scores and mood and anxiety scores. Multivariable regression models, with and without ADI, were estimated for overall cognitive phenotype and for mood and anxiety scores.ResultsA total of 800 patients (median age 38 years; 58% female) met all inclusion criteria. Effects of disadvantage (increasing ADI) were observed across nearly all measured cognitive domains and with significant increases in symptoms of depression and anxiety. Furthermore, patients in more disadvantaged ADI quintiles had increased odds of a worse cognitive phenotype (p= 0.013). Patients who self-identified as members of minoritized groups were overrepresented in the most disadvantaged ADI quintiles and were 2.91 (95% CI 1.87–4.54) times more likely to be in a severe cognitive phenotype than non-Hispanic White individuals (p< 0.001). However, accounting for ADI attenuated this relationship, suggesting neighborhood deprivation may account for some of the relationship between race/ethnicity and cognitive phenotype (ADI-adjusted proportional odds ratio 1.82, 95% CI 1.37–2.42).DiscussionThese findings highlight the importance of environmental factors and regional characteristics in neuropsychological studies of epilepsy. There are many potential mechanisms by which neighborhood disadvantage can adversely affect cognition (e.g., fewer educational opportunities, limited access to health care, food insecurity/poor nutrition, and greater medical comorbidities). Future research will seek to investigate these potential mechanisms and determine whether structural and functional alterations in the brain moderate the relationship between ADI and cognition.

The Importance of Understanding Neighborhood Environments in Neurology Care

“…Overall, Busch et al 5 suggested that the ADI was associated with neuropsychological functioning in this cross-sectional complete case analysis. Additional prospective studies with valid and comprehensive longitudinal data are needed to address the methodological limitations (e.g., selection, confounding, and information biases) observed in this descriptive study.…”

“…2,3 Although substantial research has documented disparities in individual-level social needs in people with epilepsy, scant research exists examining associations between community-level SDOH and epilepsy outcomes. [3][4][5] In this issue of Neurology ® , Busch et al 5 publish a study that examined the associations between neighborhood deprivation and neuropsychological function in older adolescents and adults with temporal lobe epilepsy (TLE), primarily from Ohio and surrounding states. The authors are commended for conducting a timely study aimed at bringing greater attention to the role of SDOH on neurologic status and outcomes.…”

The relationship between mood and anxiety and cognitive phenotypes in adults with pharmacoresistant temporal lobe epilepsy

“…We hypothesize that this is likely due in large part to social and environmental factors, as we have recently shown that neighborhood disadvantage (as assessed by the Area Deprivation Index) is associated with cognitive phenotype in TLE. 47 Further studies, in more diverse clinical samples, are needed to better understand these complex relationships. Finally, research has shown improvements in cognition with amelioration of mood and anxiety symptoms in individuals with depressive disorders.…”

Exploring Depression and Nutritional Covariates Amongst US Adults using Shapely Additive Explanations

“…Given the detrimental effects of depression, it is imperative to increase research on potential treatments and interventions 14,15 . Lifestyle changes, including diet and exercise, have been identified as potential avenues for treatment 16–20 .…”

“…Given the detrimental effects of depression, it is imperative to increase research on potential treatments and interventions. 14,15 Lifestyle changes, including diet and exercise, have been identified as potential avenues for treatment. [16][17][18][19][20] In addition, there is a growing body of evidence on specific nutritional targets that are inversely associated with depression.…”