Bi-directional association between epilepsy and dementia

Abstract

ObjectivesTo assess the risk of incident epilepsy among participants with prevalent dementia, and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).MethodsWe analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy we used separate, nested, case-control designs and matched each case to 3 age-, sex- and FHS cohort-matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and apolipoprotein ε4 allele status in modifying the association between epilepsy and dementia.ResultsA total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded HR = 1.82 [95% CI:1.05–3.16], p = 0.034. Among 43 participants with epilepsy and 129 epilepsy-free controls there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded HR = 1.99 [1.11–3.57], p = 0.021. In this group, among participants with any post-high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR = 4.67 [1.82–12.01], p = 0.001) compared to controls of the same educational attainment.ConclusionsThere is a bi-directional association between epilepsy and dementia with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.

Association of a wide range of chronic diseases and apolipoprotein E4 genotype with subsequent risk of dementia in community-dwelling adults: A retrospective cohort study

“…It could be expected that so many psychological and mental disorders were associated with an increased risk of dementia considering that they shared pathology and numerous risk factors. 18 , 31 , 32 In line with previous study, 2 although hearing impairment is not among the diseases with the largest HRs, it is the leading contributor to dementia given its high prevalence in our study. Our study underlines the importance of cardiometabolic disorders, psychological and mental disorders, and hearing impairment on the development of dementia.…”

Application of single cell genomics to focal epilepsies: A call to action

“…Interestingly, patients with AD are at increased risk of having seizures (176), which has also been corroborated in animal models of AD (177). In other words, it is possible that genotoxic damage from chronic seizures plays a role in treatment‐refractory epilepsy and could be a plausible explanation for accelerated neurodegeneration seen in patients with epilepsy (178, 179).…”

Contribution of vascular risk factors to the relationship between ADHD symptoms and cognition in adults and seniors

“…This suggests that these vascular risk factors may account for considerable variance in the relationship between clinical ADHD and 10-year dementia risk; additional prospective longitudinal studies will be needed to validate these findings in adults across the ADHD symptom severity spectrum, with richer cognitive and behavioural outcomes. Further, there has been increasing recognition of other medical and physical conditions in ADHD 12 , 76 that were not examined here but that may also contribute to cognitive changes into later adulthood, such as liver disease 77 , epilepsy 78 and obstructive sleep apnea 79 . These conditions should be explored as potential mediators in future work.…”