Feldman Lauren, Lapin Brittany, Busch Robyn M, Bautista Jocelyn F
Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Epilepsy Behav. 2018 Apr;81:18-24. doi: 10.1016/j.yebeh.2017.10.011. Epub 2018 Feb 16.
Subjective cognitive complaints are a frequent concern of patients with epilepsy. The Aldenkamp-Baker Neuropsychological Assessment Schedule (ABNAS) is a patient-reported scale validated to measure adverse cognitive effects of antiepileptic drugs (AEDs). The goals of this study were to identify predictors of patient-reported cognitive dysfunction and to assess the relationship between subjective and objective cognitive impairment.
The Cleveland Clinic Knowledge Program Data Registry was used to identify adult patients seen in outpatient epilepsy clinic from January to May 2015 and who completed the following scales: ABNAS for subjective cognitive impairment, Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder 7-item (GAD-7) scale, Quality of Life in Epilepsy (QOLIE-10), and EuroQOL five dimensions questionnaire (EQ-5D) for health-related quality of life. Topiramate (TPM) was considered a high-risk medication for cognitive impairment. Patients were categorized into groups based on total ABNAS score: subjective cognitive impairment (ABNAS>15; N=270) and no subjective cognitive impairment (ABNAS≤15; N=400). Multivariable logistic regression models were constructed to identify independent predictors of subjective cognitive impairment. In a subset of patients who had neuropsychological testing within 6months of completing the ABNAS (N=60), Pearson correlations and multivariable logistic regression models, controlling for number of AEDs, depression, and anxiety, assessed the relationship between subjective cognitive impairment and objective cognitive performance on measures of intelligence, attention/working memory, verbal fluency, naming, processing speed, manual dexterity, visuomotor processing, and verbal memory.
Forty percent of patients in the overall sample (N=270/670) reported cognitive impairment. The variables most strongly associated with subjective cognitive impairment were PHQ-9 score, number of AEDs, and seizure frequency. In the subset of patients with neuropsychological testing, ABNAS score was correlated with anxiety (r=0.44), depression (r=0.38), and attention/working memory (r=-0.31). After adjusting for depression and anxiety, patients who endorsed subjective cognitive impairment scored significantly lower on measures of nonverbal intelligence and attention/working memory, but not on other cognitive measures.
Subjective cognitive impairment as reported on the ABNAS is most strongly associated with depressive symptomatology, number of AEDs, and seizure frequency, but not with most objective cognitive measures. Identifying these three predictors provides a clear framework to understand and address subjective cognitive complaints in adult patients with epilepsy.
主观认知主诉是癫痫患者常见的关注点。阿尔登坎普 - 贝克神经心理学评估量表（ABNAS）是一种经验证的患者报告量表，用于测量抗癫痫药物（AEDs）的不良认知影响。本研究的目的是确定患者报告的认知功能障碍的预测因素，并评估主观和客观认知障碍之间的关系。
利用克利夫兰诊所知识项目数据登记库，确定2015年1月至5月在门诊癫痫诊所就诊且完成以下量表的成年患者：用于主观认知障碍的ABNAS、用于抑郁的患者健康问卷（PHQ - 9）、广泛性焦虑症7项量表（GAD - 7）、癫痫生活质量量表（QOLIE - 10）以及用于健康相关生活质量的欧洲五维健康量表（EQ - 5D）。托吡酯（TPM）被认为是一种认知损害的高风险药物。根据ABNAS总分将患者分为两组：主观认知障碍（ABNAS>15；N = 270）和无主观认知障碍（ABNAS≤15；N = 400）。构建多变量逻辑回归模型以确定主观认知障碍的独立预测因素。在完成ABNAS后6个月内进行神经心理学测试的患者亚组（N = 60）中，在控制AEDs数量、抑郁和焦虑的情况下，通过Pearson相关性分析和多变量逻辑回归模型，评估主观认知障碍与智力、注意力/工作记忆、语言流畅性、命名、处理速度、手动灵活性、视觉运动处理和语言记忆等客观认知表现之间的关系。
总体样本中40%的患者（N = 270/670）报告有认知障碍。与主观认知障碍最密切相关的变量是PHQ - 9评分、AEDs数量和癫痫发作频率。在进行神经心理学测试的患者亚组中，ABNAS评分与焦虑（r = 0.44）、抑郁（r = 0.38）和注意力/工作记忆（r = -0.31）相关。在调整抑郁和焦虑因素后，认可主观认知障碍的患者在非言语智力和注意力/工作记忆测量中的得分显著较低，但在其他认知测量中并非如此。
ABNAS报告的主观认知障碍与抑郁症状、AEDs数量和癫痫发作频率最密切相关，但与大多数客观认知测量无关。确定这三个预测因素为理解和解决成年癫痫患者的主观认知主诉提供了一个清晰的框架。
