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Exploring the relationship between everyday functioning and cognitive performance in individuals with late onset

Nour Abi Chakra1, Alexis Hankerson1, Gad A Marshall1

  • 1Neurology Department, Mass General Brigham, Boston, Massachusetts, USA.

Epilepsia
|June 26, 2026
PubMed
Summary

Functional impairment in late onset unexplained epilepsy (LOUE) is linked to cognitive decline and increased antiseizure medication (ASM) burden. The Functional Activities Questionnaire (FAQ) can help identify individuals needing support.

Keywords:
Antiseizure Medication BurdenCognitive PerformanceEveryday FunctioningLate‐Onset Unexplained Epilepsy

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Area of Science:

  • Neurology
  • Geriatrics
  • Epilepsy Research

Background:

  • Late onset unexplained epilepsy (LOUE) is associated with cognitive and functional decline.
  • Determinants of functional impairment in LOUE are not fully understood.
  • The Functional Activities Questionnaire (FAQ) is a potential tool for assessing functional status.

Purpose of the Study:

  • To evaluate the Functional Activities Questionnaire (FAQ) in adults with LOUE.
  • To examine the association between functional impairment and cognitive/epilepsy-related factors in LOUE.

Main Methods:

  • Cross-sectional study of 82 adults with LOUE (seizure onset >55 years).
  • Functional impairment assessed using the FAQ (score ≥6).
  • Cognitive function, including delayed verbal recall, was evaluated.
  • Firth penalized logistic regression identified predictors of functional impairment.

Main Results:

  • 12.2% of participants experienced functional impairment.
  • Functionally impaired individuals had worse cognitive performance and higher antiseizure medication (ASM) burden.
  • Increased ASM number and lower delayed verbal recall z-scores predicted functional impairment.
  • Memory-related cognitive tasks were most affected.

Conclusions:

  • Functional impairment in LOUE correlates with poorer cognition and greater ASM burden.
  • The FAQ is a practical screening tool for functional impairment in LOUE.
  • Minimizing medication burden is crucial for managing functional decline in this population.