Instrumental Activities of Daily Living in Older Adults with Epilepsy: A Cross-Sectional and Longitudinal Multicenter Study

Originally published in Epilepsia

Instrumental activities of daily living (IADLs) represent a critical but understudied measure of day-to-day function in people with epilepsy. In a recent multicenter study, researchers examined the proportion, clinical correlates, epilepsy-related predictors, and longitudinal trajectory of IADL impairment.

IADLs were assessed using the Functional Activities Questionnaire (FAQ). FAQ scores of ≥ 2 defined mild cognitive impairment (MCI)–level impairment, and FAQ ≥ 5 defined dementia-level functional impairment. Global cognition, individual cognitive measures, and quality of life (QOL) were compared between the impaired and unimpaired groups.  Of 57 participants, 38.6% had MCI-level functional impairment and 17.5% had dementia-level functional impairment. Worse FAQ scores were associated with lower education, early-onset epilepsy [EOE], anti-seizure medication polytherapy, and epilepsy localization.

Temporal lobe epilepsy and lower education were independently associated with baseline MCI-level functional impairment. Lower education was the only factor associated with dementia-level IADL impairment. IADL-impaired participants demonstrated lower verbal memory scores, particularly in visuospatial/executive function, attention, and memory, and worse QOL.

Longitudinally, EOE and older age were associated with greater functional decline. Four of 13 participants progressed to significantly worse function over a 2-year period, with two progressing from MCI-level to dementia-level impairment and two from normal function to MCI-level IADL impairment.

Functional impairment affected ~40% of older people. Temporal lobe localization, EOE, lower education, and poorer cognition were important determinants of baseline functional status.

Exploratory longitudinal analyses suggested that EOE and older age were associated with accelerated functional decline, although these findings require confirmation in larger cohorts. These findings provide one of the first epilepsy-specific characterizations of IADL impairment and support routine functional assessment in people with epilepsy.

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