Analysis of practical judgment in older adults with epilepsy: An exploratory, multicenter cohort study

Despite the high prevalence of cognitive deficits in older people with epilepsy (PWE), their ability to judge and make decisions in daily life remains unexplored. In 61 older PWE (55-90 years) from the multicenter BRain Aging and Cognition in Epilepsy (BrACE) study, we examined everyday judgment, as measured by the Test of Practical Judgment (TOP-J: 9 questions, score range = 0-27; higher score = better judgment) and evaluated its association with clinical and demographic characteristics, global cognition, neuropsychological performance, subjective cognition, and quality of life (QOL). In our participants (mean age ± standard deviation [SD] = 66.3 ± 6.57 years; 57.4% female), >50% scored in the range observed in individuals with mild cognitive impairment (≤21) and 10% in the range similar to people with dementia (≤16). Multivariable analysis revealed that education was the only demographic factor associated with TOP-J performance. Pearson correlation analysis revealed that lower TOP-J scores were associated with lower global cognition, language, and abstraction/executive function. Lower TOP-J scores were also associated with poorer QOL and self-reported cognitive complaints. These data suggest that the TOP-J may be a viable screening tool for early identification of reduced judgment. This could guide appropriate interventions in clinical practice, especially when older PWE present with deficits in language and executive function.