Monitoring cognition in people with epilepsy and intellectual disability

Monitoring cognition is essential in patients with epilepsy and intellectual disability (ID) to assess the course of the disease and its treatment. Patients with developmental or non-developmental ID are particularly vulnerable, as they more frequently experience severe medical conditions (such as seizures) and cognitive or psychiatric comorbidities than individuals with average intelligence. Given the difficulties in assessing patients with ID, this study aims to contextualise the current field of cognitive screening for patients with epilepsy and moderate or severe ID. To this purpose, this narrative review offers a critique of current approaches and provides a practical framework for individualised patient care. Furthermore, it highlights the challenges in assessing cognitive and behavioural changes in this population and focuses on the need for assessments that adapt to individual patient capabilities. It addresses the specific cognitive domains that should be evaluated and provides an overview of the tools employed, analysing the advantages and limitations of subjective and objective measures. Finally, it examines different procedures for assessing cognitive changes and considers future directions, such as the potential for new technologies, to improve exploration accuracy. In conclusion, objective screening tools to monitor intrasubject short-term changes in this population are necessary. The current approach is eclectic, which combines various age-adjusted and domain-specific tests. Future efforts should incorporate measures based on the WHO International Classification of Functioning, daily living activity scales, and surrogate markers for cognition (e.g., eye-tracking, AI-driven motion analysis, and wearables) to fill diagnostic gaps and improve the precision of cognitive monitoring in these patients.