From the Epilepsy Center (R.M.B., L.J., L.F.), Department of Neurology (R.M.B., L.J.), Neurological Institute, Department of Quantitative Health Sciences (J.E.D., N.I.K.), and Center for Computational Life Sciences (L.J.), Lerner Research Institute, Cleveland Clinic, OH; and Department of Neurology (A.F.S., B.P.H.), University of Wisconsin School of Medicine and Public Health, Madison.
Neurology. 2023 Jun 6;100(23):e2350-e2359. doi: 10.1212/WNL.0000000000207266. Epub 2023 Apr 19.
Temporal lobe epilepsy (TLE) is the most common adult form of epilepsy and is associated with a high risk of cognitive deficits and depressed mood. However, little is known about the role of environmental factors on cognition and mood in TLE. This cross-sectional study examined the relationship between neighborhood deprivation and neuropsychological function in adults with TLE.
Neuropsychological data were obtained from a clinical registry of patients with TLE and included measures of intelligence, attention, processing speed, language, executive function, visuospatial skills, verbal/visual memory, depression, and anxiety. Home addresses were used to calculate the Area Deprivation Index (ADI) for each individual, which were separated into quintiles (i.e., quintile 1 = least disadvantaged and quintile 5 = most disadvantaged). Kruskal-Wallis tests compared quintile groups on cognitive domain scores and mood and anxiety scores. Multivariable regression models, with and without ADI, were estimated for overall cognitive phenotype and for mood and anxiety scores.
A total of 800 patients (median age 38 years; 58% female) met all inclusion criteria. Effects of disadvantage (increasing ADI) were observed across nearly all measured cognitive domains and with significant increases in symptoms of depression and anxiety. Furthermore, patients in more disadvantaged ADI quintiles had increased odds of a worse cognitive phenotype ( = 0.013). Patients who self-identified as members of minoritized groups were overrepresented in the most disadvantaged ADI quintiles and were 2.91 (95% CI 1.87-4.54) times more likely to be in a severe cognitive phenotype than non-Hispanic White individuals ( < 0.001). However, accounting for ADI attenuated this relationship, suggesting neighborhood deprivation may account for some of the relationship between race/ethnicity and cognitive phenotype (ADI-adjusted proportional odds ratio 1.82, 95% CI 1.37-2.42).
These findings highlight the importance of environmental factors and regional characteristics in neuropsychological studies of epilepsy. There are many potential mechanisms by which neighborhood disadvantage can adversely affect cognition (e.g., fewer educational opportunities, limited access to health care, food insecurity/poor nutrition, and greater medical comorbidities). Future research will seek to investigate these potential mechanisms and determine whether structural and functional alterations in the brain moderate the relationship between ADI and cognition.
颞叶癫痫（TLE）是最常见的成人癫痫类型，与认知功能缺陷和抑郁情绪的高风险相关。然而，关于环境因素对 TLE 患者认知和情绪的影响知之甚少。本横断面研究旨在探讨社区剥夺与 TLE 成人神经心理学功能之间的关系。
从 TLE 患者的临床登记处获取神经心理学数据，包括智力、注意力、处理速度、语言、执行功能、视空间技能、言语/视觉记忆、抑郁和焦虑的测量。为每个个体计算区域剥夺指数（ADI），并将其分为五分位数（即五分位数 1=最不受益，五分位数 5=最受益）。采用 Kruskal-Wallis 检验比较五分位数组的认知域评分和情绪及焦虑评分。在有无 ADI 的情况下，采用多变量回归模型估计整体认知表型和情绪及焦虑评分。
共有 800 名（中位年龄 38 岁；58%为女性）符合所有纳入标准的患者纳入研究。在几乎所有测量的认知领域都观察到不利因素（ADI 增加）的影响，并且抑郁和焦虑症状显著增加。此外，ADI 较高五分位数组的患者认知表型较差的可能性增加（ = 0.013）。自认为属于少数族裔群体的患者在最不利的 ADI 五分位数中所占比例过高，与非西班牙裔白人相比，他们处于严重认知表型的可能性高 2.91 倍（95%CI 1.87-4.54； < 0.001）。然而，考虑到 ADI 后，这种关系减弱了，这表明社区剥夺可能是种族/民族与认知表型之间关系的部分原因（ADI 调整后的比例优势比为 1.82，95%CI 1.37-2.42）。
这些发现强调了环境因素和区域特征在癫痫神经心理学研究中的重要性。社区劣势可能通过多种潜在机制对认知产生不利影响（例如，教育机会较少、医疗保健获取有限、食物不安全/营养不良以及更多的合并症）。未来的研究将寻求调查这些潜在机制，并确定 ADI 与认知之间的关系是否受大脑结构和功能改变的调节。
