Insights From Comprehensive Research on Epilepsy and Cognitive Decline: Ifrah Zawar, MD

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The assistant professor of neurology at the University of Virginia talked about findings from a comprehensive study on epilepsy and mild cognitive impairment, which was recently presented at AES 2023. [WATCH TIME: 5 minutes]

WATCH TIME: 5 minutes

“I think the main takeaway is that epilepsy should be identified promptly, and we should treat it aggressively to try to get the seizures under control. Also, cardiovascular risk factors are important considerations when we are thinking about cognitive decline in older adults with epilepsy. So, getting cardiovascular risk factors such as hypertension and diabetes under control is also extremely important because these are modifiable risk factors that can be altered with appropriate management.”

Patients with epilepsy frequently have cognitive impairment which may be influenced by a variety of interlinked factors, including early onset, frequency, intensity, and duration of seizures, along with the use of antiseizure medicines. The majority of cognitive problems in adult patients who live with epilepsy include deficits in memory, attention and executive function. Modifications in signaling pathways and neuronal networks have an essential role in both the pathophysiology of epilepsy and in the mechanism responsible for cognitive impairment. Research has also shown the use of polytherapy in epilepsy with antiseizure medications may increase the risk for cognitive impairment.1 However, it has also been speculated that polytherapy is typically used in patients with more severe epilepsy and therefore, the severity of epilepsy may have a bigger role to play than the epilepsy itself.

Recent findings from a large study showed that patients with epilepsy experience an earlier decline in memory function, especially if they have cardiovascular risk factors like high blood pressure or diabetes, than those without the condition. These findings were presented at the 2023 American Epilepsy Society Annual Meeting, held December 1-5, in Orlando, Florida, by Ifrah Zawar, MD, an assistant professor of neurology at the University of Virginia, and colleagues.2 In the study, investigators assessed the transition from healthy cognition to mild cognitive impairment (MCI) and MCI to dementia in patients with and without epilepsy, while also observing cardiovascular risk factors.

After the meeting, Zawar sat down in an interview with NeurologyLive® to further discuss the findings from the study. She talked about how the presence of epilepsy impacts the timeline for developing MCI or dementia, and the demographic factors that were considered in the study. Zawar also spoke about the key takeaways regarding the relationship between epilepsy, cognitive decline, and the importance of managing modifiable cardiovascular risk factors. In the context of older adults with epilepsy, she also shared the future steps that are being proposed in terms of identifying and managing risk factors to improve early screening and intervention.

Click here for more coverage of AES 2023.

REFERENCES
1. Novak A, Vizjak K, Rakusa M. Cognitive Impairment in People with Epilepsy. J Clin Med. 2022;11(1):267. Published 2022 Jan 5. doi:10.3390/jcm11010267
2. Epilepsy Associated with Early Cognitive Decline, Study Finds; Cardiovascular Disease Risk Factors Amplify Likelihood. News Release. Published December 1, 2023. Accessed December 7, 2023. https://aesnet.org/about/about-aes/press-room/epilepsy-associated-with-early-cognitive-decline-study-finds

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