SAN DIEGO – By the age of 65, patients with epilepsy were found to have reduced cognitive function, a higher prevalence of depression and anxiety, and poorer sleep hygiene compared with their seizure-free peers, data from a small cross-sectional study showed.
The finding “underscores the need for looking at age-specific effects in epilepsy rather than assuming that everyone in the adult population is the same,” Dr. Sheryl R. Haut said in an interview during a poster session at the annual meetings of the American Epilepsy Society and the Canadian League Against Epilepsy. “When you're evaluating patients with epilepsy who are over the age of 65, you should be specifically inquiring not only about seizure frequency, but you must inquire and perhaps screen for depression, anxiety, and sleep [problems], because these are having an impact on their quality of life.”
Dr. Haut, of the department of neurology at Montefiore Medical Center and Albert Einstein College of Medicine, New York, and her associates recruited 32 patients aged 65 years and older who had a diagnosis of epilepsy confirmed by an epileptologist and 32 age-matched controls who had no history of seizures. The researchers administered a battery of tests to all study participants, including the Blessed Information Memory and Concentration Test (BIMC), the Prime-MD Depression and Anxiety Scale, and the Medical Outcomes Study (MOS) Sleep Scale.
The mean BIMC scores were significantly higher for epilepsy patients, showing a higher level of cognitive disturbance versus controls (6.3 vs. 1.2, respectively); while the mean Prime-MD Depression scores were significantly worse for epilepsy patients versus controls (4.2 vs. 0.8, respectively). Six cases (18%) met criteria for depression.
Similarly, the mean Prime-MD Anxiety scores were significantly worse for patients with epilepsy compared with controls (3.7 vs. 0.0, respectively).
Dr. Haut also reported that epilepsy patients scored significantly worse than controls on the MOS Sleep Scale measures of somnolence and shortness of breath/headache (13.1 vs. 3.3, respectively).
“Even though you sometimes assume that the elderly overall have worse sleep and may be more prone to depression and anxiety, in fact it's specific to epilepsy in our study,” she said. “What was surprising was that the depression and anxiety prevalence was so much higher in the cases than in the controls. In fact, none of the controls scored significantly in the anxiety scales whereas many of the cases did.”
She noted that she has started to include the battery of tests used in the study in her routine care of elderly epilepsy patients. “You can give them to the patient to take home and bring back to you. These are useful screening tests that don't take a long time to fill out.”
The study was supported in part by the National Institutes of Health and by an unrestricted grant from Pfizer Inc.
Mean depression scores were significantly worse for epilepsy patients compared with controls (4.2 vs. 0.8). DR. HAUT