A neurologist explains why diagnosing — and telling aside — epilepsy, cognitive decline, and dementia may be so sophisticated.
As individuals age, the wear and tear and tear on their blood vessels attributable to hypertension, ldl cholesterol, or different cardiovascular danger components, damages the mind and predisposes it to quite a lot of completely different illnesses together with dementia and epilepsy — a dysfunction characterised by recurrent seizures.
Epilepsy isn’t a uncommon situation both. Within the U.S., it impacts roughly three million adults. And because it seems, epilepsy could make the mind extra weak to Alzheimer’s and different types of dementia. Scientists have discovered that seizures may cause a construct up of beta-amyloid plaques, an indicator of Alzheimer’s.
That is the place issues get sophisticated: Whereas epilepsy could improve the chance of growing dementia, dementia could improve the chance of growing epilepsy by as a lot as 5 to 10 instances. “The presence of epilepsy in dementia has been proven to be related to quicker cognitive decline and worse outcomes,” Dr. Irfah Zawar, a neurologist and assistant professor on the College of Virginia, Charlottesville instructed Being Affected person. “We discovered epilepsy to be independently related to mortality in individuals with dementia.”
Epilepsy and dementia are additionally straightforward to confuse for each other when standing alone: Some varieties of seizures may cause non permanent confusion and reminiscence issues that appear to be dementia, and that may result in a misdiagnosis of gentle cognitive impairment or dementia in individuals who solely have epilepsy.
Epilepsy can pace up cognitive decline
In December 2023, Zawar offered current analysis findings on the American Epilepsy Society Annual Assembly that counsel individuals with epilepsy who’ve worse cardiovascular well being are at a good larger danger of growing MCI and dementia. The research checked out 13,700 cognitively wholesome contributors over the course of 14 years, and about 1 p.c of those contributors had epilepsy.
“We discovered that folks with epilepsy had earlier conversion [to MCI],” she defined. These with excessive ldl cholesterol, blood strain, or diabetes have been much more more likely to develop the cognitive impairment over a 14-year interval. Folks with lively epilepsy have been additionally growing dementia a number of years sooner than individuals with epilepsy who have been in remission and people who didn’t have epilepsy within the first place.
Nonetheless, Zawar and her colleagues didn’t have a whole lot of details about the kind of epilepsy individuals had, or a whole lot of particulars on which anti-seizure drugs they have been taking. That is particularly vital information to account for, as — including to the intertangling of epilepsy and mind well being — some anti-seizure drugs have been proven to probably present a small reminiscence enhance.
Epilepsy is usually confused for cognitive decline
Based on Zawar, some individuals with a type of epilepsy referred to as temporal lobe epilepsy may be misdiagnosed with dementia.
They expertise transient epileptic amnesia which causes as much as a number of minutes of forgetfulness or excessive confusion.
“Sufferers have [these] episodes usually after they get up the place they’re utterly forgetful,” Zawar mentioned. “They’re nonetheless in a position to discuss to you, however they will’t recall something.” They could neglect their maiden identify, the place they’re, and even their very own date of start.
The primary distinction between these epilepsy and dementia is that forgetfulness may be very episodic. Individuals who have seizures once they get up will return to their baseline cognitive operate a couple of minutes later. In the meantime, individuals with dementia or different types of cognitive decline might be impaired all through the whole day.
“As a result of these are episodes of forgetfulness, and never essentially like chewing, or staring off unresponsively, individuals suppose that is the onset of dementia,” she added.
Cognitive impairment is a situation that causes reminiscence issues, confusion, and different issues with considering and planning. It’s typically prompted by Alzheimer’s or one other type of dementia, or a slew of different circumstances like vitamin deficiencies, metabolic issues, melancholy, and sleep issues.
In epilepsy, the mind’s electrical indicators begin to misfire inflicting recurrent seizures. If the misfiring happens within the a part of the mind that’s concerned in reminiscence, it may result in temporary bouts of confusion and reminiscence issues. In contrast to cognitive impairment or dementia, these signs are non permanent.
How do medical doctors inform the distinction between epilepsy and early indicators of dementia?
Ensuring individuals obtain an correct prognosis can guarantee their underlying situation, whether or not it’s MCI, dementia, or epilepsy is handled appropriately.
Diagnosing dementia is sophisticated. It includes cognitive assessments to measure the extent of cognitive impairment, blood assessments to search for any underlying circumstances that would trigger cognitive decline. A lumbar puncture or amyloid PET scan can be used to rule out or affirm an Alzheimer’s prognosis — the most typical type of dementia.
Proper now, when individuals go in to get examined for dementia, they seldom obtain a check that may detect epilepsy — electroencephalography. An EEG includes sticking a bunch of electrodes onto an individual’s head to search for abnormalities within the mind’s electrical signaling. Typically, Zawar defined, individuals might want to get an EEG whereas they’re sleeping to detect temporal lobe epilepsy.
“We all know that the diagnostic delay of epilepsy in individuals with dementia may be a number of years as a result of seizures usually current with confusion in individuals with dementia,” Zawar mentioned. “They have already got some delicate ongoing cognitive deficits and confusion and since the seizures are so delicate, they’re so usually missed.”
To handle these points, she is researching new methods and strategies to enhance the prognosis of epilepsy in individuals with dementia.
