Zawar Ifrah, Kapur Jaideep, Mattos Meghan M, Manning Carol, Hashmi Syeda Amrah, Quigg Mark
Comprehensive Epilepsy Program, Department of Neurology, University of Virginia, Charlottesville, Virginia, USA.
School of Nursing, University of Virginia, Charlottesville, Virginia, USA.
Ann Clin Transl Neurol. 2025 Aug;12(8):1608-1618. doi: 10.1002/acn3.70099. Epub 2025 Jun 11.
Cognitive disorders are common in older persons with seizures (PWS). Cognitive disorders are often associated with impaired Instrumental Activities of Daily Living (IADLs). However, the effects of seizures on IADLs remain unexplored. This study (9/2005-3/2024) from 42 US Alzheimer's Disease Research Centers examined baseline and longitudinal IADL decline in cognitively normal and cognitively impaired participants grouped as active seizures (past 12 months), remote seizures (history but none in 12 months), and controls (no seizures).
Pfeffer Functional Activities Questionnaire (FAQ) measured IADLs. ANOVA compared individual and total FAQ by seizure and cognitive status. Multivariable linear regression adjusted FAQ for seizure status, age, sex, and education. ANOVA compared the rate of longitudinal FAQ decline across seizure groups. Post hoc analyses identified group differences.
Among 20,486 cognitively normal participants (average age = 69.7 years, female = 65% [N = 13,370]), IADLs were worse among 114 active seizure participants (adjusted-mean-difference [95% confidence interval (CI)]: active vs. remote = 0.69 (0.23, 1.14), p = 0.0011, active vs. controls = 0.85 (0.46, 1.24), p < 0.001). Among 30,238 cognitively impaired participants (average age = 72.2 years, female = 52% [N = 15,632]), IADLs were worse among 735 active seizure participants (adjusted-mean-difference (95% CI): active vs. remote = 6.85 (5.59, 8.10), p < 0.001, active vs. controls = 8.93 (8.06, 9.80), p < 0.001). Longitudinally, IADLs in cognitively normal adults declined faster in active seizure participants than in controls (p = 0.0396). Active seizure participants struggled most with managing taxes, traveling, paying bills, and remembering appointments.
Active seizures are associated with worse baseline IADLs and a faster rate of longitudinal decline in IADLs. These findings highlight the significant need to assess IADLs in routine clinical care in older PWS regardless of their cognition to identify those needing assistance.
认知障碍在癫痫发作的老年人（PWS）中很常见。认知障碍通常与工具性日常生活活动（IADL）受损有关。然而，癫痫发作对IADL的影响仍未得到探索。这项来自美国42个阿尔茨海默病研究中心的研究（2005年9月 - 2024年3月），对认知正常和认知受损的参与者进行了分组，包括活动性癫痫发作（过去12个月内）、既往癫痫发作（有病史但12个月内无发作）和对照组（无癫痫发作），研究了基线和纵向IADL下降情况。
使用 Pfeffer 功能活动问卷（FAQ）测量IADL。方差分析（ANOVA）按癫痫发作情况和认知状态比较个体和总FAQ。多变量线性回归对癫痫发作状态、年龄、性别和教育程度调整后的FAQ进行分析。方差分析比较各癫痫发作组纵向FAQ下降率。事后分析确定组间差异。
在20486名认知正常的参与者中（平均年龄 = 69.7岁，女性 = 65% [N = 13370]），114名活动性癫痫发作参与者的IADL较差（调整后平均差异[95%置信区间（CI）]：活动性癫痫发作组与既往癫痫发作组 = 0.69（0.23，1.14），p = 0.0011，活动性癫痫发作组与对照组 = 0.85（0.46，1.24），p < 0.001）。在30238名认知受损的参与者中（平均年龄 = 72.2岁，女性 = 52% [N = 15632]），735名活动性癫痫发作参与者的IADL较差（调整后平均差异（95% CI）：活动性癫痫发作组与既往癫痫发作组 = 6.85（5.59，8.10），p < 0.001，活动性癫痫发作组与对照组 = 8.93（8.06，9.80），p < 0.001）。纵向来看，认知正常成年人中，活动性癫痫发作参与者的IADL下降速度比对照组更快（p = 0.0396）。活动性癫痫发作参与者在管理税务、旅行、支付账单和记住预约方面困难最大。
活动性癫痫发作与更差的基线IADL以及IADL更快的纵向下降速度相关。这些发现突出表明，在老年PWS的常规临床护理中，无论其认知情况如何，都有必要评估IADL，以识别那些需要帮助的人。
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