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Utilization and yield of EEG in the elderly population
Peter Widdess-Walsh1, Bernard J Sweeney, Roderick Galvin
1Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. widdesp@ccf.org
Summary
Electroencephalography (EEG) in elderly patients shows low yield for focal abnormalities in common referrals like syncope. However, EEG abnormalities are more frequent in the "old old" and often accompanied by common electrocardiogram (ECG) findings.
Area of Science:
- Neurology
- Geriatrics
- Clinical Neurophysiology
Background:
- Electroencephalography (EEG) is frequently used in the elderly for indications including syncope, encephalopathy, and seizures.
- Understanding the diagnostic yield of EEG in this demographic is crucial for appropriate clinical management.
Purpose of the Study:
- To analyze the spectrum and incidence of EEG abnormalities in a homogenous cohort of elderly patients referred for specific neurological indications.
- To evaluate the yield of EEG for common referrals and compare findings with previous literature.
Main Methods:
- Retrospective analysis of 300 EEG records from elderly patients in Southern Ireland.
- Patients were referred for indications such as syncope, encephalopathic states, transient unresponsiveness, and clinical seizures.
Main Results:
- Generalized slowing was observed in 30.7% and focal abnormalities in 9% of EEGs.
- Epileptiform abnormalities (sharp waves) were found in 3% of EEGs for syncope referrals, lower than previously reported.
- EEG abnormalities were more common in patients over 80 years old.
- Electrocardiogram (ECG) abnormalities were prevalent (23%).
Conclusions:
- The diagnostic yield of EEG for focal abnormalities in common elderly referrals like syncope and encephalopathy is low.
- Older age (over 80) is associated with a higher incidence of EEG abnormalities.
- The high incidence of ECG abnormalities underscores their importance in this patient group.