by Isabella Colonna
For April we selected Tai XY, Torzillo E, Lyall DM, Manohar S, Husain M, Sen A. Association of Dementia Risk With Focal Epilepsy and Modifiable Cardiovascular Risk Factors. JAMA Neurol. 2023 Mar 27:e230339. doi: 10.1001/jamaneurol.2023.0339. Epub ahead of print. PMID: 36972059; PMCID: PMC10043806.
Epilepsy has been associated with increased risk of cognitive decline; however, it is still unclear how much epilepsy influences the risk of dementia and how modifiable cardiovascular risk factors may increase this risk.
Our paper of the month reports the results of a cross-sectional study based on data from the UK Biobank, which is a population-based cohort involving more than 500,000 subjects aged 38 to 72 years. Study participants underwent baseline assessment from 2006 to 2010, and follow-up evaluation until 2021.
The main aim of the study was to investigate the association between focal epilepsy and risk of incident dementia compared with patients with stroke or migraine and with healthy controls. The work included 3,864 subjects with a diagnosis of focal nongenetic epilepsy, 6,397 participants with a history of stroke, and 14,518 patients affected by migraine. A total of 134,249 individuals had low cardiovascular risk, while 274,098 and 86,802 presented with a moderate and high cardiovascular risk, respectively
At baseline, subjects with focal epilepsy showed worse executive function than controls and migraine patients, while no significant differences were found in comparison to stroke patients. At the follow-up, patients with focal epilepsy had higher adjusted hazard ratios for incident dementia than subjects with stroke and migraine. Moreover, patients with epilepsy and high cardiovascular risk had a 13-fold increased risk of dementia compared to individuals without epilepsy and with low cardiovascular risk. The use of multiple antiseizure medications was associated with worse executive functions but not with higher risk of developing dementia. Furthermore, focal epilepsy was related to lower hippocampal and total grey matter volumes than controls; however, no significant differences were found in white matter hyperintensity volume.
In conclusion, this work showed that focal epilepsy was associated with worse executive function, increased incident dementia risk and widespread brain changes. Moreover, the risk of developing dementia was increased in epilepsy patients with high cardiovascular risk; these findings suggest that the control of modifiable cardiovascular risk factors may help to reduce dementia risk in patients with epilepsy.