COGNITIVE IMPAIRMENT AFTER THE DIAGNOSIS OF LATE‐ONSET EPILEPSY ‐ A SYSTEMATIC REVIEW

Abstract

AbstractBackgroundThe management of late‐onset epilepsy in older people (LOE) is often suboptimal despites its high incidence. The impact of LOE is not only epileptic, it also leads to multiple consequences, such as cognitive decline, and other geriatric syndromes. Cognitive decline, as one of the major consequences of LOE, causes in turn deterioration in quality of life and loss of autonomy. However, the effect of de novo LOE on cognitive decline without dementia in older people remains poorly understood. Similarly, very few studies have analysed the risk factors associated with cognitive decline. Therefore, we conducted a systematic review to describe the long‐term effect on cognition of LOE on older people, including the incidence of cognitive decline after the diagnosis of LOE and the associated risk factors.MethodAccording to PRISMA 2020 guidelines, we searched 5 electronic databases (“EMBASE”, “Medline”, “CINAHL”, “PsycINFO”, “Web of Science”) for articles published until 27th Oct 2022. The criteria selected were patients “60 years old and older” with “late onset epilepsy” diagnosis and “cognitive decline” or “cognitive impairment”, whom do not have known brain tumor or a posttraumatic etiology. Four researchers independently screened studies based on the title and abstract, then by full text. Data extraction was done through “Covidence” platform with each study being processed by two reviewers and conflicts were solved by a third reviewer.ResultWe selected 26 out of 326 initially retrieved publications based on full text review. Most of the studies conducted so far however did not take into consideration or did not control for the baseline cognitive status of their patients before or at the onset of epilepsy and therefore could not objectively determine the real burden of late onset epilepsy on cognitive impairment in this population.ConclusionData in favour of a causal relationship between late onset epilepsy and cognitive decline in elderly with no known baseline cognitive impairment is still precarious. More studies should be conducted with more specific assessment tools that could permit us to have a better estimate of the burden of LOE on cognition such for example imaging and neuropsychological assessment before and after the incidence of epilepsy.