Vascular risk factors as independent predictors of neurocognitive impairments in patients with late-onset epilepsy who have small-vessel disease

Turón, Marc; Abraira, Laura; Cazorla, Sonia; Fonseca, Elena Zucconi Galli; Quintana, Manuel; Toledo, Manuel; Salas‐Puig, Xavier; Santamarina, Estevo

doi:10.1016/j.yebeh.2019.106443

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…Because aging causes general brain atrophy and cortical thinning, which may increase the partial volume effects (Slosman et al, 2001), and may disrupt the relationship between CBF and intrinsic functional connectivity via neurovascular dysregulation (Galiano et al, 2019). In terms of smoking, previous studies have shown smoking habit was associated with cognitive decline, lower cortical volumes and higher WMH volumes (Cox et al, 2019;Turon et al, 2020). Smoking was associated with ischemic CSVD as revealed by the state-of-the-art study (Larsson et al, 2019).…”

Section: Discussionmentioning

confidence: 98%

Alterations of the Whole Cerebral Blood Flow in Patients With Different Total Cerebral Small Vessel Disease Burden

Qiu

et al. 2020

Front. Aging Neurosci.

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Background: Cerebral small vessel disease (CSVD) is a common age-related vascular disease of the brain associated with slowly accumulating tissue damage. At present, total CSVD burden score is a commonly used method to evaluate the severity of the disease. Purpose: To observe whether global and regional cerebral perfusion is related to total CSVD score and to explore global and regional cerebral blood flow (CBF) changes in patients with different degrees of CSVD. Methods: We collected 130 subjects with different total burden score of CSVD (0 point: 33 subjects, 1 point: 39 subjects, 2 points: 24 subjects, 3 points: 24 subjects, 4 points: 10 subjects). Total CSVD burden score was evaluated by clinically routine sequences (T2WI, T2-FLAIR, T1WI, DWI, and SWAN sequence). Global and regional CBF were calculated and correlation analysis was used to investigate the relationship between total CSVD score and CBF of the whole brain and several brain regions. Results: The analysis results showed that there was a negative correlation between total CSVD burden score and global CBF (r = −0.33, p = 0.001). Total CSVD burden score also had moderately negative correlations with CBF of almost all the brain regions. Conclusion: CSVD is a disease that affects the whole brain. With the increase of total CSVD burden score, the global and regional CBF decreased. The CSVD total burden score could be used to evaluate the overall condition of brain perfusion.

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Section: Discussionmentioning

confidence: 98%

Alterations of the Whole Cerebral Blood Flow in Patients With Different Total Cerebral Small Vessel Disease Burden

Qiu

et al. 2020

Front. Aging Neurosci.

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“…Given that the small number of studies that have exclusively focused on LOE have included cognitive screeners or had a limited number of neuropsychological tests (22)(23)(24)(35)(36)(37)(38)(39), the full characterization of cognitive profiles in LOE remains to be examined. In this study, we show that in a population of older adults with LOE who completed a cross-sectional assessment, cognitive impairment is common across a comprehensive battery of tests with rates of impairment ranging from 27% to 48%, with measures of set-shifting, delayed recall, semantic fluency, and processing speed the most prevalent.…”

Section: Cognitive Impairment In Loementioning

confidence: 99%

“…Despite increased awareness of the elevated risk of dementia in individuals with LOE and identification of risk factors for the development of LOE, the nature of cognitive deficits in this clinical population has not been fully characterized. Although several studies have examined cognitive impairments in older adults with epilepsy (25-34), only a few studies have exclusively focused on LOE (22)(23)(24)(35)(36)(37)(38)(39), and most of these studies have used neuropsychological screening tools with limited sensitivity that do not enable a comprehensive analysis of cognitive profiles in this growing population.…”

Section: Introductionmentioning

confidence: 99%

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

Reyes,

Schneider,

Kucharska-Newton

et al. 2023

Front. Neurol.

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IntroductionCognitive 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.MethodsParticipants 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).ResultsAt 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.DiscussionOur 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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“…За останніми епідеміологічними даними, постінсультна епілепсія становить приблизно 10% усіх епілепсій та 55% вперше виниклих нападів серед людей похилого віку [11]. Такий самий двобічний зв'язок інсульт і постінсультна епілепсія мають із когнітивними розладами, причому розвиток деменції у цих хворих пояснюється більшою мірою не епілептичним процесом, а наявністю хвороби дрібних судин -як етіології епілепсії -та судинними факторами ризику (тютюнопаління, цукровий діабет, артеріальна гіпертензія, дисліпідемія) [12].…”

Section: результати та їх обговоренняunclassified

Пізня Епілепсія: Особливості Діагностики Та Лікування

Marienko¹,

Marienko²

2021

UMJ

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Анотація. Зростання захворюваності на епілепсію у людей літнього віку пояснюється збільшенням тривалості життя і покращенням діагностики епілептичних нападів у похилому віці. Мета роботи -вивчення даних сучасної наукової літератури щодо особливостей етіології, клініки, діагностики та лікування епілепсії з пізнім початком у людей літнього віку. Обговорюються етіологічні чинники пізньої епілепсії, роль факторів ризику цереброваскулярних захворювань, які водночас впливають і на розвиток пізньої епілепсії. Розглядається можливість виникнення пізньої епілепсії внаслідок церебральної хвороби дрібних судин при невідомій етіології епілепсії та за відсутності чітких структурних змін на магнітно-резонансній томографії. Обговорюється коморбідність пізньої епілепсії з деменцією. Наведені особливості феноменології епілептичних нападів у осіб похилого віку та значення електроенцефалографії, яка нерідко не виявляє епілептиформних порушень. Наведено клінічний випадок труднощів діагностики пізньої епілепсії. Для лікування пацієнтів із пізньою епілепсією рекомендуються протиепілептичні препарати нового покоління з відносно невеликою кількістю лікарських взаємодій, такі як ламотриджин, леветирацетам та габапентин, які в той самий час мають найменший вплив на когнітивні функції пацієнтів. Ключові слова: епілепсія, похилий вік, пізня епілепсія, діагностика, лікування.

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Vascular risk factors as independent predictors of neurocognitive impairments in patients with late-onset epilepsy who have small-vessel disease

Cited by 9 publications

References 31 publications

Alterations of the Whole Cerebral Blood Flow in Patients With Different Total Cerebral Small Vessel Disease Burden

Alterations of the Whole Cerebral Blood Flow in Patients With Different Total Cerebral Small Vessel Disease Burden

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

Пізня Епілепсія: Особливості Діагностики Та Лікування

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