Cognitive-behavioral screening in elderly patients with new-onset epilepsy before treatment

Abstract

Objectives -Cognitive comorbidity at epilepsy onset reflects disease severity and provides a baseline estimate of reserve capacities with regard to the effects of epilepsy and its treatment. Given the high incidence of epilepsy at an older age, this study analyzed objective and subjective cognition as well as quality of life in elderly patients with new-onset focal epilepsy before initiation of anti-epileptic treatment. Materials and methods -A total of 257 untreated patients (60-95 years of age) with new-onset epilepsy underwent objective assessment of executive function (EpiTrack) and performed subjective ratings of cognition (Portland Neurotoxicity Scale) and quality of life (QoL; QOLIE-31). Results -According to age-corrected norms, 58% of patients (N = 257) demonstrated deficits in executive function; major determinants were cerebrovascular etiology, neurological comorbidity, and higher body mass index. Subjective ratings indicated deficits in up to 27% of patients. Self-perceived deficits were associated with neurological, cardiovascular, and/or psychiatric comorbidity, whereas poorer QoL was related to neurological comorbidity and female gender. Objectively assessed executive functions correlated with subjective social functioning, energy, motor function, and vigilance. Conclusions -We found a relatively high QoL, a low rate of subjective impairment, but a high incidence of objective executive deficits in untreated elderly patients with new-onset epilepsy. Neurological status and body mass index, rather than seizure frequency or severity, were risk factors for cognitive impairment. Given the relevance of cognition in the course of epilepsy and its treatment, routine screening before treatment initiation is highly recommended.J. The cognitive status of patients with new-onset epilepsy has recently been identified as a neuropsychological research topic of major relevance (1). Early identification of cognitive problems would allow timely intervention before the emergence of negative psychosocial consequences. As far as studies in untreated adult patients with newly diagnosed epilepsy have been conducted, the results revealed deficits primarily in attention, executive functions, and memory (2-8). The patients' mean age in these studies was in the range of 30-47 years. Considering that the incidence of epilepsy varies across the life span, with peaks during both maturation and senescence of the brain, data on the cognitive status of elderly patients with new-onset epilepsy would be highly appreciated. In elderly patients with epilepsy, comorbidities accumulate, and cerebrovascular etiologies (e.g., stroke) represent one of the leading causes of epilepsy (9,10).In this study, we analyzed executive function, subjective complaints, and quality of life (QoL) in a large sample of elderly patients with new-onset focal epilepsy before the initiation of anti-epileptic treatment.

Attention and executive functions in the early course of pediatric epilepsy

“…These specific functions often are summarized by the umbrella term "executive functions" and are known to be highly vulnerable in children with epilepsy [4,21,[30][31][32] as well as in children with different neurobiological risk conditions, e.g., preterm children [33]. Nevertheless, the screening tool does not assess other cognitive domains that might also be affected, e.g., sustained attention, memory, or language.…”

Paradigm Shifts in the Neuropsychology of Epilepsy

“…Indeed, adults and elders with new onset epilepsies display a pattern of mild diffuse cognitive impairment at diagnosis and prior to treatment with medications (Taylor et al, 2010; Witt & Helmstaedter, 2012; Witt et al, 2014), with an abnormal prospective 1 year and 5 year cognitive course that predominantly affects memory, executive function and psychomotor speed (Baker, Taylor, Aldenkamp et al, 2011; Taylor & Baker, 2010) (See Witt & Helmsteadter, 2015 for review ). In children with new onset epilepsies, evident at or near the time of diagnosis, and even preceding the first recognized seizure, are elevated rates of behavioral problems including ADHD, depression and anxiety, early life histories of academic struggles and provision of special academic services, with a pattern of distributed cognitive anomalies (Pohlmann-Eden et al, 2015).…”

Comparative effectiveness of levetiracetam, valproate and carbamazepine among elderly patients with newly diagnosed epilepsy: subgroup analysis of the randomized, unblinded KOMET study

“…Characteristics of epilepsy, such as etiology, clinical manifestations, and electroencephalogram (EEG) findings differ between elderly and younger populations [4–7]. Among the elderly, cerebrovascular disease is the leading identifiable cause of epilepsy; others include trauma, dementia and brain tumours, typically gliomas, meningiomas, and brain metastases [6, 8–10].…”