Seizures in Dementia are Associated with Worse Clinical Outcomes, Higher Mortality and Shorter Lifespans (P3-1.001)

Abstract

<h3>Objective:</h3> To study impact of seizures on clinical and mortality outcomes in dementia patients. <h3>Background:</h3> Dementia and seizures are both public health imperatives. Seizures occur in 10–64% of those with dementia and accelerate cognitive decline. However, the impact of seizures on clinical and mortality outcomes in dementia patients has not been studied. <h3>Design/Methods:</h3> We analyzed longitudinal data from 39 Alzheimer’s disease Centers from 9/2005–12/2021, maintained by National Alzheimer’s Coordinating Center. We included patients with cognitive impairment at initial visit. We compared cognitive, functional and mortality outcomes among those with and without seizures. <h3>Results:</h3> At the initial visit, among 26,425 cognitively impaired patients, 374(1.4% point prevalence) had seizures. Seizure patients were significantly younger (62.91 vs 68.4 years, p&lt;0.001) at onset of cognitive decline. In multivariate regression analysis, dominant Alzheimer’s disease(AD) mutation(OR: 5.55, CI: 2.39–12.89, p &lt; 0.001), stroke (OR: 3.17, CI: 2.35–4.27, p &lt; 0.001), transient ischemic attack[TIA] (OR: 1.72, CI: 1.21–2.46, p = 0.003), traumatic brain injury[TBI] (OR: 1.92, CI: 1.48–2.50, p &lt; 0.001), Parkinson’s disease [PD] (OR: 1.79, CI: 1.07–2.98, p = 0.025), depression (OR: 1.61, CI: 1.30–1.99, p &lt; 0.001) and lower education (OR: 0.97, CI: 0.95–0.99, p = 0.043) were associated with seizures. Patients with seizures performed worse on mini-mental-status examination(18.50 vs 22.88, <i>p</i> &lt; 0.001) and Clinical-Dementia-Rating Sum-of-boxes(7.95 vs 4.28, p &lt; 0.001); and had more physical dependence(OR: 2.52, CI: 1.99–3.19, p &lt; 0.001) compared to those without seizures after adjusting for age and dementia duration using generalized linear model. Analysis of longitudinal mortality data showed that a higher proportion of seizure patients had died (OR: 1.56, CI: 1.27–1.91, p &lt; 0.0001),and they were younger at death(72.99 vs 79.72years, p &lt; 0.001). Multivariate survival analysis using Cox regression was conducted to study age at death and seizure status. We adjusted the model for sex, disease duration, stroke, TIA, TBI, depression, education and dominant AD mutation. Despite adjustment, patients with seizures were at a higher risk of dying at a younger age(hazard ratio: 1.76, CI: 1.49–2.08, p&lt;0.001). <h3>Conclusions:</h3> Our study shows that dementia patients with seizures have worse cognition and higher mortality rates at a younger age compared to dementia patients without seizures. Dementia patients with early onset of dementia, dominant AD mutation, stroke, TIA, TBI, PD, depression, and/or lower education are more likely to have seizures. Dementia patient with these risk factors may be routinely considered for EEG for early identification and treatment of seizures to improve outcomes. <b>Disclosure:</b> Dr. Zawar has nothing to disclose. Dr. Quigg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerebral Therapeutics. Dr. Quigg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerebral Therapeutics. Dr. Quigg has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Finnigen and Harrison. Dr. Quigg has received research support from NIH. Dr. Quigg has received publishing royalties from a publication relating to health care. The institution of Dr. Manning has received research support from Department of Defense. The institution of Dr. Kapur has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Marinus. Dr. Kapur has received personal compensation in the range of $5,000-$9,999 for serving as an officer or member of the Board of Directors for Robert Wood Johnson Foundation . Dr. Kapur has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Kapur has received research support from NIH. Dr. Kapur has received intellectual property interests from a discovery or technology relating to health care. Dr. Kapur has a non-compensated relationship as a Chair, Board North America with International League against Epilepsy that is relevant to AAN interests or activities. Dr. Kapur has a non-compensated relationship as a Board of Directors with American Epilepsy Society that is relevant to AAN interests or activities.