Risk Factors Associated With Late-Onset Epilepsy in Dementia and Mild Cognitive Impairment

Area of Science:

• Neurology
• Geriatrics
• Cognitive Science

Background:

• Late-onset epilepsy (LOE) risk increases significantly after age 60, especially in individuals with cognitive decline (PWCD).
• Epilepsy is linked to poorer cognitive and mortality outcomes in PWCD, highlighting the need for early detection.
• Identifying individuals at risk for LOE can enable timely screening and intervention.

Purpose of the Study:

• To investigate the factors associated with the development of late-onset epilepsy (LOE) in people with cognitive decline (PWCD).

Main Methods:

• A longitudinal, multicenter study analyzed data from 14,685 PWCD across 39 US Alzheimer's Disease Research Centers.
• Participants were aged 60 years or older, without prior epilepsy, and followed over time.
• Multivariable Cox regression assessed associations between various factors (genetics, comorbidities, cognition, lifestyle) and LOE development.

Main Results:

• Of 14,685 participants, 221 (1.5%) developed LOE.
• Associated risk factors for LOE included the APOE4 allele, dementia onset before age 60, worse cognition, Alzheimer disease dementia, stroke/transient ischemic attack (TIA), and Parkinson disease.
• Sensitivity analysis confirmed these associations with an alternative LOE definition (onset after 65).

Conclusions:

• The APOE4 allele, early dementia onset, Alzheimer disease dementia, cognitive impairment, stroke/TIA, and Parkinson disease are significant risk factors for LOE in PWCD.
• PWCD exhibiting these risk factors may benefit from routine electroencephalogram screening for early LOE detection.
• Early identification and management of LOE in at-risk PWCD can potentially improve cognitive and mortality outcomes.