San Diego State University, University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
Center for Multimodal Imaging and Genetics, University of California, San Diego, CA, USA.
Epilepsia. 2020 Jun;61(6):1211-1220. doi: 10.1111/epi.16528. Epub 2020 May 4.
To identify cognitive phenotypes in temporal lobe epilepsy (TLE) and test their reproducibility in a large, multi-site cohort of patients using both data-driven and clinically driven approaches.
Four-hundred seven patients with TLE who underwent a comprehensive neuropsychological evaluation at one of four epilepsy centers were included. Scores on tests of verbal memory, naming, fluency, executive function, and psychomotor speed were converted into z-scores based on 151 healthy controls (HCs). For the data-driven method, cluster analysis (k-means) was used to determine the optimal number of clusters. For the clinically driven method, impairment was defined as >1.5 standard deviations below the mean of the HC, and patients were classified into groups based on the pattern of impairment.
Cluster analysis revealed a three-cluster solution characterized by (a) generalized impairment (29%), (b) language and memory impairment (28%), and (c) no impairment (43%). Based on the clinical criteria, the same broad categories were identified, but with a different distribution: (a) generalized impairment (37%), (b) language and memory impairment (30%), and (c) no impairment (33%). There was a 82.6% concordance rate with good agreement (κ = .716) between the methods. Forty-eight patients classified as having a normal profile based on cluster analysis were classified as having generalized impairment (n = 16) or an isolated language/memory impairment (n = 32) based on the clinical criteria. Patients with generalized impairment had a longer disease duration and patients with no impairment had more years of education. However, patients demonstrating the classic TLE profile (ie, language and memory impairment) were not more likely to have an earlier age at onset or mesial temporal sclerosis.
We validate previous findings from single-site studies that have identified three unique cognitive phenotypes in TLE and offer a means of translating the patterns into a clinical diagnostic criteria, representing a novel taxonomy of neuropsychological status in TLE.
在一个大型的多中心患者队列中，通过数据驱动和临床驱动的方法，识别颞叶癫痫（TLE）的认知表型，并测试其重现性。
纳入了 407 名在四个癫痫中心之一接受全面神经心理学评估的 TLE 患者。将言语记忆、命名、流畅性、执行功能和运动速度测试的分数转换为基于 151 名健康对照（HC）的 z 分数。对于数据驱动的方法，使用聚类分析（k-均值）来确定最佳聚类数。对于临床驱动的方法，损伤定义为低于 HC 平均值的 1.5 个标准差以上，根据损伤模式将患者分为组。
聚类分析显示了一种三聚类解决方案，其特征为（a）广泛损伤（29%）、（b）语言和记忆损伤（28%）和（c）无损伤（43%）。根据临床标准，也确定了相同的广泛类别，但分布不同：（a）广泛损伤（37%）、（b）语言和记忆损伤（30%）和（c）无损伤（33%）。两种方法之间的一致性率为 82.6%，具有良好的一致性（κ=0.716）。根据聚类分析被分类为正常表型的 48 名患者根据临床标准被分类为广泛损伤（n=16）或孤立的语言/记忆损伤（n=32）。广泛损伤的患者疾病持续时间更长，无损伤的患者受教育年限更多。然而，表现出经典 TLE 表型（即语言和记忆损伤）的患者并不更可能更早发病或存在内侧颞叶硬化。
我们验证了以前在单个地点研究中发现的 TLE 中有三种独特的认知表型的发现，并提供了一种将这些模式转化为临床诊断标准的方法，代表了 TLE 中神经心理学状态的一种新分类。
