Cognitive phenotypes in late-onset epilepsy: results from the atherosclerosis risk in communities study

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  • Reyes, Anny
    • Other Affiliation: University of California, San Diego
  • Schneider, Andrea L. C.
    • Other Affiliation: University of Pennsylvania
  • Kucharska-Newton, Anna M.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Gottesman, Rebecca F.
    • Other Affiliation: National Institute of Neurological Disorders and Stroke Intramural Research Program
  • Johnson, Emily L.
    • Other Affiliation: Johns Hopkins University School of Medicine
  • McDonald, Carrie R.
    • Other Affiliation: University of California, San Diego
Abstract
  • Introduction Cognitive phenotyping is a widely used approach to characterize the heterogeneity of deficits in patients with a range of neurological disorders but has only recently been applied to patients with epilepsy. In this study, we identify cognitive phenotypes in older adults with late-onset epilepsy (LOE) and examine their demographic, clinical, and vascular profiles. Further, we examine whether specific phenotypes pose an increased risk for progressive cognitive decline. Methods Participants were part of the Atherosclerosis Risk in Communities Study (ARIC), a prospective longitudinal community-based cohort study of 15,792 individuals initially enrolled in 1987–1989. LOE was identified from linked Centers for Medicare and Medicaid Services claims data. Ninety-one participants with LOE completed comprehensive testing either prior to or after seizure onset as part of a larger cohort in the ARIC Neurocognitive Study in either 2011–2013 or 2016–2017 (follow-up mean = 4.9 years). Cognitive phenotypes in individuals with LOE were derived by calculating test-level impairments for each participant (i.e., ≤1 SD below cognitively normal participants on measures of language, memory, and executive function/processing speed); and then assigning participants to phenotypes if they were impaired on at least two tests within a domain. The total number of impaired domains was used to determine the cognitive phenotypes (i.e., Minimal/No Impairment, Single Domain, or Multidomain). Results At our baseline (Visit 5), 36.3% met criteria for Minimal/No Impairment, 35% for Single Domain Impairment (with executive functioning/ processing speed impaired in 53.6%), and 28.7% for Multidomain Impairment. The Minimal/No Impairment group had higher education and occupational complexity. There were no differences in clinical or vascular risk factors across phenotypes. Of those participants with longitudinal data (Visit 6; n = 24), 62.5% declined (i.e., progressed to a more impaired phenotype) and 37.5% remained stable. Those who remained stable were more highly educated compared to those that declined. Discussion Our results demonstrate the presence of identifiable cognitive phenotypes in older adults with LOE. These results also highlight the high prevalence of cognitive impairments across domains, with deficits in executive function/processing speed the most common isolated impairment. We also demonstrate that higher education was associated with a Minimal/No Impairment phenotype and lower risk for cognitive decline over time.
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  • Article
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  • Attribution 4.0 International
Journal title
  • Frontiers in Neurology
Journal volume
  • 17
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  • English
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  • 1664-2295
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  • Frontiers Media SA

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