Cognitive deterioration in adult epilepsy : clinical characteristics of “accelerated cognitive ageing"

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives
“Epileptic dementia” is reported in adults with childhood-onset refractory epilepsy. Cognitive deterioration can also occur in a “second-hit model”.

Materials and methods
We studied the clinical and neuropsychological characteristics of patients with cognitive deterioration (≥1 SD discrepancy between current IQ and premorbid IQ). Memory function, reaction time and processing speed were also evaluated. Analyses were performed to investigate which clinical characteristics correlated with cognitive deterioration.

Results
Twenty-seven patients were included with a mean age of 55.7 years old, an average age at epilepsy onset of 33.9 years and a mean duration of 21.8 years. Over 40% had experienced at least one status epilepticus. About 77.8% had at least one comorbid disease (most of (cardio)vascular origin). Cognitive deterioration scores were significant for both Performance IQ and Full Scale IQ, but not for Verbal IQ. Impairments in fluid functions primarily affected the IQ-scores. Memory was not impaired. Epilepsy factors explained 7% of the variance in deterioration, whereas 38% was explained by relatively low premorbid IQ and educational level, high age at seizure onset and older age.

Conclusions
A subgroup of patients with localization-related epilepsy exhibits cognitive decline characterized by deterioration in PIQ and FSIQ, but with preserved higher order functions (VIQ and memory). Patients typically have epilepsia tarda, comorbid pathology, relatively low educational level and older age. These are factors known to increase the vulnerability of the brain by diminishing cognitive reserve. Cognitive deterioration may develop according to a stepwise “second-hit model”, affecting and accelerating the cognitive ageing process.
LanguageEnglish
Pages47–53
Number of pages7
JournalActa Neurologica Scandinavica
Volume136
Issue number1
Early online date28 Oct 2016
DOIs
StatePublished - 1 Jun 2017

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Epilepsy
Age of Onset
Cognitive Reserve
Partial Epilepsy
Status Epilepticus
Reaction Time
Blood Vessels
Dementia
Seizures
Pathology
Cognitive Aging
Brain

Cite this

@article{66fcdc6527ee41aebad631df98e110b3,
title = "Cognitive deterioration in adult epilepsy : clinical characteristics of “accelerated cognitive ageing{"}",
abstract = "Objectives“Epileptic dementia” is reported in adults with childhood-onset refractory epilepsy. Cognitive deterioration can also occur in a “second-hit model”.Materials and methodsWe studied the clinical and neuropsychological characteristics of patients with cognitive deterioration (≥1 SD discrepancy between current IQ and premorbid IQ). Memory function, reaction time and processing speed were also evaluated. Analyses were performed to investigate which clinical characteristics correlated with cognitive deterioration.ResultsTwenty-seven patients were included with a mean age of 55.7 years old, an average age at epilepsy onset of 33.9 years and a mean duration of 21.8 years. Over 40{\%} had experienced at least one status epilepticus. About 77.8{\%} had at least one comorbid disease (most of (cardio)vascular origin). Cognitive deterioration scores were significant for both Performance IQ and Full Scale IQ, but not for Verbal IQ. Impairments in fluid functions primarily affected the IQ-scores. Memory was not impaired. Epilepsy factors explained 7{\%} of the variance in deterioration, whereas 38{\%} was explained by relatively low premorbid IQ and educational level, high age at seizure onset and older age.ConclusionsA subgroup of patients with localization-related epilepsy exhibits cognitive decline characterized by deterioration in PIQ and FSIQ, but with preserved higher order functions (VIQ and memory). Patients typically have epilepsia tarda, comorbid pathology, relatively low educational level and older age. These are factors known to increase the vulnerability of the brain by diminishing cognitive reserve. Cognitive deterioration may develop according to a stepwise “second-hit model”, affecting and accelerating the cognitive ageing process.",
author = "L. Breuer and E. Grevers and Boon, {Paul A.J.M.} and A. Bernas and J.W.M. Bergmans and R.M.H. Besseling and D.C.W. Klooster and {de Louw}, A.J.A. and R.M.C. Mestrom and K. Vonck and S. Zinger and A.P. Aldenkamp",
year = "2017",
month = "6",
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doi = "10.1111/ane.12700",
language = "English",
volume = "136",
pages = "47–53",
journal = "Acta Neurologica Scandinavica",
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}

Cognitive deterioration in adult epilepsy : clinical characteristics of “accelerated cognitive ageing". / Breuer, L.; Grevers, E.; Boon, Paul A.J.M.; Bernas, A.; Bergmans, J.W.M.; Besseling, R.M.H.; Klooster, D.C.W.; de Louw, A.J.A.; Mestrom, R.M.C.; Vonck, K.; Zinger, S.; Aldenkamp, A.P.

In: Acta Neurologica Scandinavica, Vol. 136, No. 1, 01.06.2017, p. 47–53 .

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Cognitive deterioration in adult epilepsy : clinical characteristics of “accelerated cognitive ageing"

AU - Breuer,L.

AU - Grevers,E.

AU - Boon,Paul A.J.M.

AU - Bernas,A.

AU - Bergmans,J.W.M.

AU - Besseling,R.M.H.

AU - Klooster,D.C.W.

AU - de Louw,A.J.A.

AU - Mestrom,R.M.C.

AU - Vonck,K.

AU - Zinger,S.

AU - Aldenkamp,A.P.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objectives“Epileptic dementia” is reported in adults with childhood-onset refractory epilepsy. Cognitive deterioration can also occur in a “second-hit model”.Materials and methodsWe studied the clinical and neuropsychological characteristics of patients with cognitive deterioration (≥1 SD discrepancy between current IQ and premorbid IQ). Memory function, reaction time and processing speed were also evaluated. Analyses were performed to investigate which clinical characteristics correlated with cognitive deterioration.ResultsTwenty-seven patients were included with a mean age of 55.7 years old, an average age at epilepsy onset of 33.9 years and a mean duration of 21.8 years. Over 40% had experienced at least one status epilepticus. About 77.8% had at least one comorbid disease (most of (cardio)vascular origin). Cognitive deterioration scores were significant for both Performance IQ and Full Scale IQ, but not for Verbal IQ. Impairments in fluid functions primarily affected the IQ-scores. Memory was not impaired. Epilepsy factors explained 7% of the variance in deterioration, whereas 38% was explained by relatively low premorbid IQ and educational level, high age at seizure onset and older age.ConclusionsA subgroup of patients with localization-related epilepsy exhibits cognitive decline characterized by deterioration in PIQ and FSIQ, but with preserved higher order functions (VIQ and memory). Patients typically have epilepsia tarda, comorbid pathology, relatively low educational level and older age. These are factors known to increase the vulnerability of the brain by diminishing cognitive reserve. Cognitive deterioration may develop according to a stepwise “second-hit model”, affecting and accelerating the cognitive ageing process.

AB - Objectives“Epileptic dementia” is reported in adults with childhood-onset refractory epilepsy. Cognitive deterioration can also occur in a “second-hit model”.Materials and methodsWe studied the clinical and neuropsychological characteristics of patients with cognitive deterioration (≥1 SD discrepancy between current IQ and premorbid IQ). Memory function, reaction time and processing speed were also evaluated. Analyses were performed to investigate which clinical characteristics correlated with cognitive deterioration.ResultsTwenty-seven patients were included with a mean age of 55.7 years old, an average age at epilepsy onset of 33.9 years and a mean duration of 21.8 years. Over 40% had experienced at least one status epilepticus. About 77.8% had at least one comorbid disease (most of (cardio)vascular origin). Cognitive deterioration scores were significant for both Performance IQ and Full Scale IQ, but not for Verbal IQ. Impairments in fluid functions primarily affected the IQ-scores. Memory was not impaired. Epilepsy factors explained 7% of the variance in deterioration, whereas 38% was explained by relatively low premorbid IQ and educational level, high age at seizure onset and older age.ConclusionsA subgroup of patients with localization-related epilepsy exhibits cognitive decline characterized by deterioration in PIQ and FSIQ, but with preserved higher order functions (VIQ and memory). Patients typically have epilepsia tarda, comorbid pathology, relatively low educational level and older age. These are factors known to increase the vulnerability of the brain by diminishing cognitive reserve. Cognitive deterioration may develop according to a stepwise “second-hit model”, affecting and accelerating the cognitive ageing process.

U2 - 10.1111/ane.12700

DO - 10.1111/ane.12700

M3 - Article

VL - 136

SP - 47

EP - 53

JO - Acta Neurologica Scandinavica

T2 - Acta Neurologica Scandinavica

JF - Acta Neurologica Scandinavica

SN - 1600-0404

IS - 1

ER -