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Dementia patients with seizures declined faster and died younger than those without seizures, prospective data from showed.

Across more than 26,000 cognitively impaired people in 39 U.S. centers, those with active seizures had more advanced cognitive impairment and worse functional skills, reported Ifrah Zawar, MD, of the University of Virginia School of Medicine in Charlottesville.

They also had a younger age at death (73 vs 80, P<0.001), she said in a presentation at the 2022 American Epilepsy Society annual meeting.

"It's important to recognize that seizures in dementia are associated with worse cognitive, clinical, and functional outcomes and early mortality," Zawar told 番茄社区app. "For these reasons, they need to be recognized and treated early on."

Seizures are often misdiagnosed in dementia patients; they can be subtle and mistaken for typical signs of dementia, she added.

Zawar and colleagues analyzed longitudinal data from 39 Alzheimer's research centers participating in the NIH . Clinical data spanned from September 2005 to December 2021. All participants had cognitive impairment at their initial visit; more than half had dementia.

Among 26,425 participants, 374 (1.4%) had active seizures, defined as seizures in the past 1 year, or ones that required active treatment. Those with seizures were younger at cognitive decline onset (63 vs 68, P<0.001), and younger at their first study visit (69 vs 73, P<0.001).

People with active seizures were more likely to have a prior diagnosis of stroke, transient ischemic attack (TIA), Parkinson's disease, or a history of traumatic brain injury (TBI). They also were more likely to have had post-traumatic stress disorder (PTSD) and active depression in the past 2 years. Six of the 374 people with active seizures had a dominant Alzheimer's gene mutation.

Participants with seizures performed worse on the 30-point Mini-Mental Status Examination (18.50 vs 22.88 points, P<0.001) and the 18-point Clinical Dementia Rating Scale-Sum of Boxes (7.95 vs 4.28 points, P<0.001) than people without seizures, after adjusting for age and duration of cognitive decline. They also had worse functional assessment scores and were more likely to have physical dependence (OR 2.52, 95% CI 1.99-3.19, P<0.001).

Over the study follow-up period, people with seizures were more likely to die (OR 1.56, 95% CI 1.27-1.91, P<0.0001). In a survival model adjusted for sex, disease duration, stroke, TIA, TBI, depression, education, and Alzheimer's genes, participants with active seizures had a higher risk of dying at a younger age (HR 1.76, 95% CI 1.49-2.08, P<0.001).

The study focused only on seizures among people with cognitive impairment and did not show causality, Zawar noted. "We know dementia patients are more likely to have seizures, and people who have seizures are more likely to develop dementia, but it's still a chicken-and-egg question regarding which one causes the other," she said.

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