Risk Factors for Late-Onset Epilepsy in Patients With Cognitive Decline Identified
Factors linked with an increased risk of late-onset epilepsy (LOE) in people with cognitive decline (PWCD) include Parkinson disease, onset of dementia before the age of 60 years, worse cognition, stroke or transient ischemic attack, Alzheimer disease subtype of dementia, and apolipoprotein E4 (APOE4) allele, according to study results published online ahead of print in JAMA Neurology.
“PWCD with these risk factors may be considered for routine screening with an electroencephalogram for early identification of LOE,” wrote first author Ifrah Zawar, MD, MS-CR, of the University of Virginia Department of Neurology, Charlottesville, Virginia, and study coauthors.
Because epilepsy in patients with cognitive decline is associated with worse cognitive and mortality outcomes, researchers investigated factors associated with the development of LOE in the patient population.
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The study included 14,685 people with cognitive decline (defined as dementia or mild cognitive impairment) and without epilepsy at enrollment. Participants were from 39 US Alzheimer’s Disease Research Centers between September 2005 and December 2021 and were 60 years or older at the most recent follow-up.
Among participants, 221 developed LOE, defined as recurrent seizures starting at or after age 60 years, over longitudinal follow-up.
Adjusted hazard ratios for LOE development were 2.53 with Parkinson disease, 2.46 with dementia onset before age 60 years, 2.35 with worse cognition, 2.03 with stroke or transient ischemic attack, 1.68 with Alzheimer disease dementia subtype, and 1.39 with APOE4 allele in multivariable Cox regression analysis, according to the study.
“In sensitivity analysis,” researchers added, “using an alternative LOE definition of epilepsy onset after age 65 years revealed the same factors associated with LOE.”
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