Prevalence of Dementia in a Level 4 Epilepsy Center: How Big Is the Problem?

Abstract

Abstract Background: To evaluate how prominent the currently hot issue of “epilepsy and dementia” is in the daily practice of a large level 4 epilepsy university clinic. Methods: In this retrospective monocentric cohort study, a total of 145,501 letters of all 40,360 adult patients seen between 2003 and 2021 were screened for dementia related terms. Files with at least on hit were extracted and analyzed in regard to diagnoses, age, age at epilepsy onset, and the question of whether epilepsy preceded or followed the diagnosis of dementia. Results: This resulted in 513 patients who had at least one hit. Of those, 12.7% respectively 6.6% definitively had or were suspected to have dementia, 4.9% had Mild Cognitive Impairment, and 6.6% other neurodegenerative conditions. Referring to all patients, a diagnosed or suspected dementia prevalence of 0.25% is indicated. An older age (>age 60), late-onset epilepsy (>age 60), but not a longer duration of epilepsy increased the odds by 6.1 and 3.1. Additionally, vascular, metabolic, inflammatory, and behavioral mood related comorbidities were common. Epilepsy preceded rather than followed the dementia diagnosis. Conclusions: Considering an eventual selection bias and under-diagnosis because not all patients were explicitly screened for dementia, the results put the dementia issue from an epileptologist’s point of view into perspective. The prevalence of dementia in epilepsy is low. However, physicians should be aware that the risk for dementia is increased in the elderly, in late onset epilepsies, and with comorbid risk factors, and that seizures can be the early sign of a neurodegenerative disease. Future research needs to screen for dementia in epilepsy more explicitly while stratifying the patients according to the underlying pathologies and comorbidities.