The authors wrote, “Seizures are common in dementia and associated with accelerated cognitive decline. However, the impact of active vs remote seizures on cognition remains understudied.”
This study’s objective was to examine the impact of active versus remote seizures on the cognition of patients with normal cognition and mild cognitive impairment (MCI).
The study cohort comprised patients recruited from 39 Alzheimer’s Disease Centers in the United States between September 2005 and December 2021. All participants with normal cognition and MCI and at least two visits were included.
The primary outcome was cognitive decline, measured by utilizing the Clinical Dementia Rating (CDR) scale. Patients were categorized into two groups: normal-to-impaired (CDR ≥0.5) and MCI-to-dementia (CDR ≥1).
The study evaluated the impact of active seizures (within the past 12 months), remote seizures (previous seizures but none in the past 12 months), and no seizures (controls) on cognitive function. Additionally, subgroups with chronic seizures at enrollment and new-onset seizures were investigated. To evaluate the risk of all-cause MCI and/or dementia, adjusting for age, gender, education, race, hypertension, and diabetes, researchers employed Cox regression models.
Of the 13,726 participants with normal cognition at enrollment (9,002 [66%] female; median age 71 years), 118 experienced active seizures and 226 had remote seizures. Among the 11,372 participants with mild cognitive impairment (MCI) at enrollment (5,605 [49%] female; median age 73 years), 197 had active seizures and 226 had remote seizures.
The researchers wrote, “Active seizures were associated with 2.1 times higher risk of cognitive impairment (adjusted hazard ratio [aHR] 2.13, 95% CI 1.60–2.84, P < 0.001) in cognitively healthy adults (median years to decline: active seizures =; 1, remote seizures = ; 3, no seizures =; 3) and 1.6 times higher risk of dementia (aHR 1.58, 95% CI 1.24–2.01, P < 0.001) in those with MCI (median years to decline: active seizures =; 1, remote seizures =; 2, controls =; 2). This risk was not observed with remote seizures.”
Based on their findings, the authors concluded that compared with those with remote seizures, individuals with active seizures are at a greater risk of developing MCI and dementia, regardless of other cognitive decline risk factors such as age, gender, race, education, and cardiovascular risks. Moreover, new-onset seizures pose a meaningfully greater risk of cognitive decline than chronic seizures in both cognitively healthy older adults and those with MCI.
The authors wrote, “Hence, new-onset seizures in older adults may be an indicator of heralding dementia. Therefore, early identification and aggressive management of seizures in cognitively normal adults and those with MCI may present a path to mitigation of cognitive decline in the aging population of epilepsy.“
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