Prevalence and Causes of Seizures at the Time of Diagnosis of Probable Alzheimer’s Disease

Lozsádi, Dora A.; Larner, AJ

doi:10.1159/000093664

Cited by 123 publications

(88 citation statements)

References 51 publications

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“…Nutritional education programmes for caregivers of patients with AD may help to resolve this problem [27] . We also found that epilepsy was more commonly diagnosed in AD, and a previous study, which reported that 6.8% of their AD patients had a history of epilepsy, supports this observation [28] .…”

Section: Discussionsupporting

confidence: 89%

Reasons for Hospital Admissions in Dementia Patients in Birmingham, UK, during 2002–2007

Natalwala

Potluri

Uppal³

et al. 2008

Dement Geriatr Cogn Disord

111

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Background: There is a lack of evidence to explain why patients with dementia are admitted to a general hospital. Methods: Main reasons for hospitalisation were investigated in all patients admitted to a multi-ethnic general hospital during 2002–2007, by analysis of type of admission and primary diagnosis on admission. Anonymised data from the Hospital Activity Analysis Register was used to trace these patients; 505 were diagnosed with Alzheimer’s disease (AD), 283 with vascular dementia (VD) and 1,773 patients were classified as unspecified dementia (UnD). Logistic regression analysis was used to compare these groups to 53,123 age-matched controls. Statistical significance of p < 0.001 was accepted. Results: More dementia patients were admitted as emergency cases compared to controls (AD = 95.8%, VD = 95.4%, UnD = 96.7%, controls = 54.4%; p < 0.001 for all comparisons). The proportion of patients admitted for dementia as their primary diagnosis was small (AD = 5.9%, VD = 10.6%, UnD = 6.0%). Primary diagnoses such as syncope and collapse, bronchopneumonia, urinary tract infection and dehydration were more frequent in all dementia patients than controls. Conclusion: Dementia patients are frequently admitted as emergency cases, but dementia itself is often not the primary diagnosis. Earlier detection of the specific conditions mentioned above may reduce emergency hospital admissions amongst dementia patients.

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Section: Discussionsupporting

confidence: 89%

Reasons for Hospital Admissions in Dementia Patients in Birmingham, UK, during 2002–2007

Natalwala

Potluri

Uppal³

et al. 2008

Dement Geriatr Cogn Disord

111

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“…Prevalence of unprovoked seizures in Alzheimer's disease (AD) is significantly higher than in age-matched control populations (Hauser et al, 1986;Mendez et al, 1994;Hesdorffer et al, 1996;Amatniek et al, 2006;Lozsadi and Larner, 2006). The risk of epileptic seizures is particularly high in AD patients with earlyonset dementia and during early stages of the disease, reaching an 87-fold increase in seizure incidence compared with an agematched reference population (Amatniek et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Amyloid β-Induced Neuronal Hyperexcitability Triggers Progressive Epilepsy

Minkeviciene¹,

Rheims²,

Dobszay³

et al. 2009

J. Neurosci.

582

544

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Alzheimer's disease is associated with an increased risk of unprovoked seizures. However, the underlying mechanisms of seizure induction remain elusive. Here, we performed video-EEG recordings in mice carrying mutant human APPswe and PS1dE9 genes (APdE9 mice) and their wild-type littermates to determine the prevalence of unprovoked seizures. In two recording episodes at the onset of amyloid ␤ (A␤) pathogenesis (3 and 4.5 months of age), at least one unprovoked seizure was detected in 65% of APdE9 mice, of which 46% had multiple seizures and 38% had a generalized seizure. None of the wild-type mice had seizures. In a subset of APdE9 mice, seizure phenotype was associated with a loss of calbindin-D28k immunoreactivity in dentate granular cells and ectopic expression of neuropeptide Y in mossy fibers. In APdE9 mice, persistently decreased resting membrane potential in neocortical layer 2/3 pyramidal cells and dentate granule cells underpinned increased network excitability as identified by patch-clamp electrophysiology. At stimulus strengths evoking single-component EPSPs in wild-type littermates, APdE9 mice exhibited decreased action potential threshold and burst firing of pyramidal cells. Bath application (1 h) of A␤1-42 or A␤25-35 (proto-)fibrils but not oligomers induced significant membrane depolarization of pyramidal cells and increased the activity of excitatory cell populations as measured by extracellular field recordings in the juvenile rodent brain, confirming the pathogenic significance of bath-applied A␤ (proto-)fibrils. Overall, these data identify fibrillar A␤ as a pathogenic entity powerfully altering neuronal membrane properties such that hyperexcitability of pyramidal cells culminates in epileptiform activity.

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“…Such provision may be required because insufficient neurological expertise is deemed available in dedicated learning disability clinics. The correct diagnosis of late-onset seizures in Down syndrome is crucial since this may herald onset of cognitive decline [11,12] , in the same way that seizure onset concurrent with the development of Alzheimer's disease has been documented in the non-Down syndrome population [13] , and hence be a marker for consideration of anti-dementia drug therapy. Such medications have been investigated in Down syndrome [4] , and although their exact place in management remains to be defined, it would seem likely that their greatest benefit will be in early cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

Down syndrome in the neurology clinic: Too much? Too little? Too late?

Larner¹

2007

Downs Syndr. Res. Pract.

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This paper presents a review of all patients with Down syndrome seen over a 5-year period by one consultant neurologist in general outpatient and specialist cognitive function clinics. It revealed only 7 cases in > 4500 general referrals (= 0.2%), all referred with suspected seizure disorders. The diagnosis of epilepsy was confirmed in 6 patients. Only one new, comorbid, diagnosis was made. Neurologists have little exposure to, and hence little chance to develop expertise in, the neurological complications of Down syndrome. It is suggested that closer liaison between neurologists and psychiatrists with an interest in learning disability might improve the management of neurological problems in patients with Down syndrome.

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Prevalence and Causes of Seizures at the Time of Diagnosis of Probable Alzheimer’s Disease

Cited by 123 publications

References 51 publications

Reasons for Hospital Admissions in Dementia Patients in Birmingham, UK, during 2002–2007

Reasons for Hospital Admissions in Dementia Patients in Birmingham, UK, during 2002–2007

Amyloid β-Induced Neuronal Hyperexcitability Triggers Progressive Epilepsy

Down syndrome in the neurology clinic: Too much? Too little? Too late?

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