Seizures in Dementia Can Worsen Clinical and Mortality Outcomes in Patients

The occurrence of seizures is associated with worse clinical outcomes and higher mortality rates among patients with dementia compared with those with dementia without seizures, according to study results presented at the 2023 American Academy of Neurology (AAN) Annual Meeting, held from April 22 to 27, 2023, in Boston, Massachusetts.

Seizures can occur in 10-64% of patients with dementia and also advance cognitive decline. However, the effect of seizures on clinical and mortality outcomes in patients with dementia has not been studied. For the study, researchers sought to assess the impact of seizures on these outcomes in this patient population.

Researchers examined longitudinal data from 39 Alzheimer disease (AD) centers from September 2005 to December 2021 maintained by the National Alzheimer’s Coordinating Center. Patients were included if they had cognitive impairment at the initial visit. The outcomes examined were cognitive function, functional outcomes, and mortality rates.

A total of 26,425 patients were included in the final analysis, and 1.4% (n=374) experienced seizures.

Researchers found a number of factors that were significantly more prevalent in patients who had seizures compared with those who did not, including:

• a history of stroke (odds ratio [OR], 3.17; 95% CI, 2.35-4.27; P <.001),
• transient ischemic attack (TIA; OR, 1.72; 95% CI, 1.21-2.46; P =.003),
• traumatic brain injury (TBI; OR, 1.92; 95% CI, 1.48-2.50; P <.001),
• Parkinson disease (PD; OR, 1.79; 95% CI, 1.07-2.98; P =.025),
• autosomal dominant AD mutations (OR, 5.55; 95% CI, 2.39-12.89; P <.001),
• lower education levels (OR, 0.97; 95% CI, 0.95-0.99, P =.043), and
• depression (OR, 1.61; 95% CI, 1.30-1.99; P <.001).

In terms of cognitive function, patients who had seizures performed worse on the mini-mental status examination (MMSE; 18.50 vs 22.88; P <.001) and Clinical Dementia-Rating Sum-of-boxes (CDR-SB; 7.95 vs 4.28; P <.001) than patients who did not have seizures.

Additionally, compared with patients with dementia who did not experience seizures, a significantly higher proportion of those with dementia who had seizures had died (OR, 1.56; 95% CI, 1.27-1.91; P <.001).

After adjusting for sex, disease duration, TIA, TBI, stroke, education level, depression, and dominant AD mutations, patients with seizures were still at a significantly higher risk for dying than patients without seizures (Hazard ratio, 1.76; 95% CI, 1.49-2.08; P <.001).

Researchers concluded that “[patients with dementia] with seizures have worse cognition and higher mortality rates at a younger age compared to [patients with dementia] without seizures.”

They also noted that certain patient factors, including “early onset of dementia, dominant AD mutation, stroke, TIA, TBI, PD, depression, and/or lower education” lead to a higher risk for seizures in patients.

Researchers suggest consideration for routine electroencephalogram testing in patients with AD who have these risk factors to identify and treat seizures early.

This article originally appeared on Neurology Advisor