Neurology: Epilepsy, vascular risk factors, and cognitive decline in older adults: a study of cardiovascular health

Recent studies have shown that older adults with epilepsy (≥ 65 years of age) tend to have a faster decline
in overall cognitive abilities over time compared to older adults without epilepsy.
There is little
information on the role of vascular risk factors (VRFs) in the cognitive process of epilepsy.
A study published in Neurology evaluated whether the association of individual VRFs with cognitive trajectories differed
due to the presence of an epileptic epidemic.

The Cardiovascular Health Study is a population-based longitudinal cohort study of 5,888 U.
S.
adults
aged ≥ 65 years.
Using a modified simple mental status test (3MS; Global Cognitive Abilities) and the Digital Sign Substitute Test (DSST; Information processing speed) measures cognitive function
.
We used a linear mixed model to estimate the association of individual and joint epilepsy and VRF with cognitive decline by modeling the interaction of epilepsy and VRF one by one, with each VRF adjusted for all other VRFs considered, including demographics, health behaviors, clinical features, and co-diagnosis
.
From these models, we estimated excess average cognitive decline
due to epilepsy interactions with each VRF.

The study observed an excessive average decline in overall cognitive ability (3 MS) due to the interaction between epilepsy and hypertension (without interaction, the mean 8-year decline
was 6.
6 points more than expected; 95% confidence interval, CI: 1.
3, 12.
0) and abstinence from alcohol (5.
8 points higher than expected, 95% confidence interval, CI: 0.
3, 11.
3).
。 We also observed excessive mean reductions in speed of information processing (DSST) due to the interaction between epilepsy and previous stroke (18.
1 points higher than expected; 95% confidence interval, CI: 7.
6, 28.
5), abstinence from alcohol (6.
1 points higher than expected; 95% confidence interval, CI: 2.
5, 9.
8), and higher triglyceride levels (2.
4 points higher than expected according to standard deviation; 95% confidence interval, CI: 0.
4, 4.
3).

In the presence of epilepsy, some VRFs are more strongly associated with cognitive decline in older adults, suggesting the need for more attention to vascular protection to protect brain health
in older adults with epilepsy.

Source: Choi H, Elkind MSV, Longstreth WT Jr, et al.
Epilepsy, Vascular Risk Factors, and Cognitive Decline in Older Adults: The Cardiovascular Health Study [published online ahead of print, 2022].
Sep 2].
Neurology.
2022; 10.
1212/WNL.
0000000000201187.
doi:10.
1212/WNL.
0000000000201187