Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia.
Department of Psychiatry, Alfred Health, Prahran, Australia.
Epilepsy Behav. 2021 Jul;120:107987. doi: 10.1016/j.yebeh.2021.107987. Epub 2021 May 9.
To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit.
This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and 'other' diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales.
Five-hundred and thirty three patients (71 older, 462 younger) aged 16-91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and 'other' in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group.
Psychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.
比较就诊于视频脑电图监测（VEM）单元的老年和年轻患者的临床、精神科和认知特征。
这是一项回顾性病例对照研究，涉及在两个全面性癫痫单位在两年期间（2018 年 4 月至 2020 年 4 月）因 VEM 入院的患者。患者被分为老年组（≥60 岁）和年轻组（<60 岁）。将年轻患者与老年患者进行个体匹配，形成匹配的年轻组。诊断由癫痫学家、神经学家和神经精神科医生的共识意见确定。主要诊断类别为癫痫、心因性非癫痫性发作（PNES）和“其他”诊断（非诊断和其他非癫痫性诊断）。临床精神科诊断来自神经精神科报告。客观认知功能通过神经精神病学单位认知评估工具（NUCOG）进行测量。主观认知功能使用癫痫生活质量问卷-89 量表（QOLIE-89）认知子量表进行评估。
在研究期间，533 名（71 名老年，462 名年轻）年龄在 16-91 岁的患者被收治到 VEM 单元。老年组 55%有局灶性癫痫诊断，年轻组 48%有局灶性癫痫诊断，老年组 3%有全面性癫痫诊断，年轻组 10%有全面性癫痫诊断，老年组 32%有“其他”诊断，年轻组 19%有“其他”诊断。老年组有 10%（2 名男性和 5 名女性）被诊断为 PNES，而年轻组有 22%（p=0.016）。老年组 34%被诊断为抑郁症，年轻组 24%（p=0.20）。老年组 15%被诊断为焦虑症，年轻组 25%（p=0.15）。老年组更常见轻度神经认知障碍（34%）与匹配的年轻组（34%对 3%，p<0.001）。老年组的 NUCOG 平均得分低于匹配的年轻组（79.49 对 87.73，p<0.001）。对于老年组，NUCOG 平均得分与整体主观认知困难之间没有证据表明存在相关性（r=0.03，p=0.83）。在老年人群中，那些被诊断为 PNES 的人有更多的童年创伤经历。在老年组中，PNES 和非 PNES 诊断之间的分离、抑郁或一般焦虑测量值没有差异。
在因 VEM 就诊的老年患者中，精神共病很常见。在年轻患者中看到的癫痫的心理影响和心因性非癫痫性发作的风险因素也适用于老年组。老年组的认知障碍比年轻组更明显，尽管这些障碍通常未被个体识别。就诊于 VEM 的老年患者将受益于精神科和神经心理学的投入，以确保全面的评估和管理方法。
