Cognitive deficits and memory problems are common among adults with chronic epilepsy. This webinar discusses the course of cognitive and memory aging in people with chronic epilepsy. The presentation addresses factors that contribute to healthy cognitive and brain aging, as well as what patients can do to help prevent cognitive decline.
This webinar is presented by Dr. Bruce Hermann, PhD, Director of the Charles Matthew Neuropsychology Section at the University of Wisconsin School of Medicine and Public Health. Dr. Hermann is an expert in brain and cognitive aging in people with chronic epilepsy. His research focuses on the impact of epilepsy on brain structure, cognition, and psychiatric status.
Dr. Hermann’s presentation is followed by an interactive Q&A session, where he answers questions such as:
- Can any measures be taken to prevent or combat the cognitive decline that accompanies getting older with epilepsy?
- Does research suggest specific therapies to help prevent memory loss associated with epilepsy?
- Are certain individuals with epilepsy more likely to experience cognitive decline as they age than others?
Q&A Transcript
How did researchers differentiate between the issues caused by antiepileptic drugs, and those that are caused by seizures?
Within the epileptic drugs, the best are the controlled clinical trials, right? And there’s quite a bit of research about that, right? So, patients come in, they’re randomized to drug A or drug B, they’re tested before they’re given those medications. And there are studies that have done this with healthy controls where they’ve taken no medications, and come into the study, and take some baseline testing, then are randomized to a drug treatment trial, and no treatment control trial.
And you can figure out the specific effects of particular drugs in that fashion. And they’ve also done this with patients with epilepsy, where they’re randomized to one arm or another, and you can look at the effects of an add-on medication or a new medication. There are now, there are some very large studies where they’ve taken people at diagnosis, and randomize them into a one arm or the other. And it could be such as the childhood absence study, which was a major national study in the US that even compare the effects of seizure control as well as cognition.
If there’s marginal or no differences in their ability to control the seizures, then really clearly the more preferred compound would be the one that has fewer cognitive complications. So, quite a big literature that addresses that through the years, and it’s been worked out pretty carefully, and I can send CURE some references for that that might be useful to everyone.
Is there research done when drugs come into the market on which medications, like Keppra that may have more of an impact on memory and cognition?
Yes. I mean, nowadays it’s worked out pretty carefully. So, we have a good sense of the cognitive complications with some of these medications. It becomes clearer over time for sure, but cognition is now integrated in many of these drug development clinical trials and so on. Again, don’t forget because what happens in my career, talk about cognition or talk about behavioral issues. Generally, the first question has to do with medications, and there’s no question that it can have an effect. But these problems are present right at the get go even before any medications are given.
Can the medications exacerbate the cognitive difficulty? Sure, they can, but they are countering the effects of the seizures themselves, which have their own adverse effects. So, this research looking at new onset drug naive patients is just incredibly important. And again, there are subsets, some individuals at onset have no difficulties, and have a very uncomplicated course, whereas others from a cognitive perspective have difficulties early on, and were struggling with some issues even before the diagnosis of epilepsy, which no one fully understands, but everybody has observed that.
Is there an advantage to adults actually having genetic testing done to determine their type of epilepsy, and could that have an impact on knowing the cognitive issues, and the memory issues that may arise?
No. I mean, I think in the cognitive aging world, and especially in the Alzheimer’s disease world, there are a couple of genes. I mean, it’s a complicated business. I work with a preclinical AAD group here, and there’s a lot of interest in genetics, and the primary gene has been the ApoE4 gene. I mean, there are genes for early onset dementia, but that’s not what people are worried about. They’re worried more about must having a family.
They’re worried more about the course over the decades, and as they get older. And there are a couple of genes, but it’s very poly genetic as they say, and you can have the gene, and not have Alzheimer’s disease. You can not have the gene and have Alzheimer’s disease. So, it’s probably what’s probably most important in midlife is probably to get after all the treatable factors, and my general opinion, and the research on that, we have folks here doing exercise research.
And in at-risk patients for Alzheimer’s disease, and the exercise has positive effects on brain structure. It has positive effects on laying down of the plaques. It has positive effects on cognition going forward. So, I’ve seen a diet study using the mind diet where white matter volumes increase over time. So, I think if you look at the websites for the various organizations I mentioned, I think that’s very important to take a look at. And it’s extremely important area of research for epilepsy. It’s just critical going forward.
Is there any research being done that shows that epilepsy patients are more or less likely to develop Alzheimer’s?
This is a very hot topic right now, and there’s a lot of interest in this, if we address it from the standpoint of comorbidity studies, is there a higher incidence between epilepsy seizures, and Alzheimer’s disease? There is a higher incidence, but that’s driven in part by people who have Alzheimer’s disease, and then develop seizures as part of that disease. The really complicated question is, and not that that’s not complicated, but the question that people with chronic epilepsy have is what’s my cognitive course?
We just don’t know too much about it because our literature cuts off about age 50. We need some large population-based studies that follow people into their older years. And that, we just don’t have. We need that, and that would include imaging, and cognition, and life health history. I think that’s why the Finland data are so important. They’ve collected all sorts of health activity, personal information on these patients at midlife. And one question would be is there anything in midlife that predicts the amyloid deposition in people in their 50s?
If something can be found there, then that would have huge implications in terms of what to do, and have some… just certainly generate testable hypotheses anyway in terms of are there things we can do to reduce that risk. And, that question is, I mean, what’s the risk of Alzheimer’s disease? It’s everywhere, you pick up the paper, listen to the news, and it drives a lot of interest in cognition.
Does epilepsy actually affect long-term memory or short-term memory, more than the other?
Yeah. I think the one thing we didn’t talk about is if you think about it, the seizures, I mean I’ve always been impressed for example, by moms who will say, “We studied for the test last night, yesterday afternoon, and Johnny knew everything, and you got cold, and you’re forwards, backwards, and had it all down, and had a seizure the night, or a seizure in the evening. And then the next morning, just didn’t recall any of the information.
They weren’t postictal, but it’s erased what they had learned. And in epilepsy, the seizures, I mean memory is a process. Consolidation takes place over time, over a long time period. And if something disrupts that process, then that won’t be remembered. And episodic seizures, and probably even the spikes, if people have some clinical seizures, and they’re not aware of, these things are taking place, and are affecting the laying down of new memories.
So, it could be that if a patient and spouse say, “Well, don’t you remember that trip we took four years ago?” They may not recall that because the consolidation process had been affected by seizures, spikes, or clinical seizures. And the subclinical seizures are really a problem because you’re not sure when those things occur. You see them in the monitoring units all the time. So, long-term memory can be affected, and it is an object of study at present.
The information contained herein is provided for general information only and does not offer medical advice or recommendations. Individuals should not rely on this information as a substitute for consultations with qualified healthcare professionals who are familiar with individual medical conditions and needs. CURE Epilepsy strongly recommends that care and treatment decisions related to epilepsy and any other medical condition be made in consultation with a patient’s physician or other qualified healthcare professionals who are familiar with the individual’s specific health situation.