@article {8622, title = {Cognitive decline in older adults with epilepsy: The Cardiovascular Health Study.}, journal = {Epilepsia}, volume = {62}, year = {2021}, month = {2021 Jan}, pages = {85-97}, abstract = {

OBJECTIVE: Cognitive decline is a major concern for older adults with epilepsy. Whether and how much faster older adults with epilepsy experience cognitive decline beyond expected age-related cognitive change remain unclear. We sought to estimate and compare rates of cognitive decline in older adults with and without epilepsy.

METHODS: The Cardiovascular Health Study is a population-based longitudinal cohort study of 5888 US adults aged 65+. Cognitive function was assessed annually with Modified Mini-Mental State Exam (3MS) and Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate average rates of decline in 3MS and DSST scores by epilepsy status (prevalent, incident, or no epilepsy), adjusted for risk factors associated with cognitive decline.

RESULTS: The rate of decline in 3MS was significantly faster in prevalent epilepsy (P~<~.001) and after incident epilepsy (P~=~.002) compared with no epilepsy. Prevalent epilepsy and apolipoprotein E gene (APOE) ε4 (ApoE4) had a synergistic interaction, whereby prevalent epilepsy and ApoE4 together were associated with 1.51 points faster annual decline in 3MS than would be expected if prevalent epilepsy and ApoE4 did not interact (P~<~.001). Older adults with prevalent epilepsy had a significantly lower initial DSST score and faster rate of decline compared to those with no epilepsy (P~<~.001).

SIGNIFICANCE: Faster decline in global cognitive ability seen in this study validates concerns of patients. ApoE4 allele status was an effect modifier of the relationship between cognitive decline and prevalent epilepsy. Further research is warranted to explore biological mechanisms and possible interventions to mitigate cognitive decline.

}, issn = {1528-1167}, doi = {10.1111/epi.16748}, author = {Choi, Hyunmi and Thacker, Evan L and Longstreth, William T and Elkind, Mitchell S V and Boehme, Amelia K} } @article {9234, title = {Epilepsy, Vascular Risk Factors, and Cognitive Decline in Older Adults: The Cardiovascular Health Study.}, journal = {Neurology}, volume = {99}, year = {2022}, month = {2022 Nov 22}, pages = {e2346-e2358}, abstract = {

BACKGROUND AND OBJECTIVES: Recent studies have shown that global cognitive ability tends to decline faster over time in older adults (>=65 years) with epilepsy compared with older adults without epilepsy. Scarce data exist about the role of vascular risk factors (VRFs) on cognitive course in epilepsy. We assessed whether the associations of individual VRFs with cognitive trajectory differed depending on the presence of prevalent epilepsy.

METHODS: The Cardiovascular Health Study is a population-based longitudinal cohort study of 5,888 US adults aged >=65 years. Cognitive function was assessed annually with modified Mini-Mental State Examination (3MS; global cognitive ability) and Digit Symbol Substitution Test (DSST; information processing speed). We used linear mixed models to estimate the individual and joint associations of epilepsy and VRFs with cognitive decline by modeling epilepsy {\texttimes} VRF interactions one by one, each adjusted for all other VRFs considered, including demographics, health behaviors, clinical characteristics, and comorbid diagnoses. From these models, we estimated excess mean cognitive decline due to interaction of epilepsy with each VRF.

RESULTS: We observed excess mean decline in global cognitive ability (3MS) due to interactions of epilepsy with hypertension (6.6 points greater mean 8-year decline than expected if no interaction; 95\% CI 1.3-12.0) and with abstaining from alcohol (5.8 points greater than expected; 95\% CI 0.3-11.3). We also observed excess mean decline in information processing speed (DSST) due to interactions of epilepsy with prior stroke (18.1 points greater mean 9-year decline than expected; 95\% CI 7.6-28.5), with abstaining from alcohol (6.1 points greater than expected; 95\% CI 2.5-9.8), and with higher triglyceride levels (2.4 points greater than expected per SD; 95\% CI 0.4-4.3).

DISCUSSION: Associations of some VRFs with cognitive decline in older adults are stronger in the presence of epilepsy, suggesting a need for greater attention to vascular protection for preserving brain health in older adults with epilepsy.

}, keywords = {Aged, Cognition, Cognitive Dysfunction, Epilepsy, Humans, Longitudinal Studies, Neuropsychological Tests, Risk Factors}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000201187}, author = {Choi, Hyunmi and Elkind, Mitchell S V and Longstreth, W T and Boehme, Amelia K and Hafen, Rebekah and Hoyt, Emma J and Thacker, Evan L} } @article {9534, title = {Hospital-Acquired Infection at Time of Stroke and Cognitive Decline: The Cardiovascular Health Study.}, journal = {Cerebrovasc Dis}, year = {2023}, month = {2023 Oct 23}, abstract = {

Introduction Hospital-acquired infections (HAIs) after stroke are associated with additional morbidity and mortality, but whether HAIs increase long-term cognitive decline in stroke patients is unknown. We hypothesized that older adults with incident stroke with HAI experience faster cognitive decline than those having stroke without HAI and those without stroke. Methods We performed a longitudinal analysis in the population-based prospective Cardiovascular Health Study. Medicare-eligible participants aged >65 years with and without incident stroke had cognition assessed annually. HAIs were assessed by hospital discharge codes. Global cognitive function was assessed annually by Modified Mini-Mental State Examination (3MSE) and executive function by Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate the mean decline and 95\% confidence intervals (95\% CI) for 3MSE and DSST scores by incident stroke and HAI status, adjusted for demographics and vascular risk factors. Results Among 5,443 participants >65 years without previous history of stroke, 393 participants had stroke with HAI (SI), 766 had a stroke only (SO), and 4,284 had no stroke (NS) throughout a maximum 9-year follow-up. For 3MSE, compared with NS participants, SO participants had a similar adjusted mean decline (additional 0.08 points/year, 95\%CI -0.15, 0.31), while SI participants had a more rapid decline (additional 0.28 points/year, 95\%CI 0.16, 0.40). Adjusted mean decline was 0.20 points/year faster (95\%CI -0.05, 0.45) among SI than SO participants. For DSST, compared with NS participants, SO participants had a faster adjusted mean decline (additional 0.17 points/year (95\%CI 0.003, 0.33), as did SI participants (additional 0.27 points/year (95\%CI 0.19, 0.35). Conclusion Stroke, when accompanied by HAI, leads to a faster long-term decline in cognitive ability than in those without stroke. The clinical and public health implications of the effect of infection on post-stroke cognitive decline warrant further attention.

}, issn = {1421-9786}, doi = {10.1159/000533568}, author = {Cole, Kyril L and Boehme, Amelia K and Thacker, Evan L and Longstreth, W T and Brown, Bruce L and Gale, Shawn D and Hedges, Dawson W and Anderson, Jacqueline K and Elkind, Mitchell S V} }