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Johnson EL, Krauss GL, Kucharska-Newton A, Albert MS, Brandt J, Walker KA, Yasar S, Knopman DS, Vossel KA, Gottesman RF. Dementia in late-onset epilepsy: The Atherosclerosis Risk in Communities study. Neurology 2020; 95:e3248-e3256. [PMID: 33097597 DOI: 10.1212/wnl.0000000000011080] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the risk of dementia after the development of late-onset epilepsy. METHODS We used data from the Atherosclerosis Risk in Communities (ARIC) cohort study, which started in 1987 to 1989 with 15,792 mostly Black and White men and women from 4 US communities. We identified late-onset epilepsy (LOE; seizures starting at age 67 or later) from linked Medicare claims data. We used a Cox proportional hazards regression model to evaluate associations between LOE and dementia through 2017 as ascertained from neuropsychological testing, interviews, and hospital discharge surveillance, and we used multinomial logistic regression to assess the risk of dementia and mild cognitive impairment in the subset with full neuropsychological assessments available. We adjusted for demographics and vascular and Alzheimer disease risk factors. RESULTS Of 9,033 ARIC participants with sufficient Medicare coverage data (4,980 [55.1%] female, 1993 [22.1%] Black), 671 met the definition of LOE. Two hundred seventy-nine (41.6%) participants with and 1,408 (16.8%) without LOE developed dementia (p < 0.001). After a diagnosis of LOE, the adjusted hazard ratio for developing subsequent dementia was 3.05 (95% confidence interval 2.65-3.51). The median time to dementia ascertainment after the onset of LOE was 3.66 years (quartile 1-3, 1.28-8.28 years). INTERPRETATION The risk of incident dementia is substantially elevated in individuals with LOE. Further work is needed to explore causes for the increased risk of dementia in this growing population.
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Affiliation(s)
- Emily L Johnson
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis.
| | - Gregory L Krauss
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Anna Kucharska-Newton
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Marilyn S Albert
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Jason Brandt
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Keenan A Walker
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Sevil Yasar
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - David S Knopman
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Keith A Vossel
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
| | - Rebecca F Gottesman
- From the Departments of Neurology (E.L.H., G.L.K., M.S.A., K.A.W., R.F.G.), Psychiatry (J.B.), Medicine (S.Y.), and Epidemiology (R.F.G.), Johns Hopkins School of Public Health, Baltimore, MD; Department of Epidemiology (A.K.-N.), University of North Carolina at Chapel Hill; Department of Epidemiology (A.K.-N.), University of Kentucky, Lexington; Department of Neurology (D.S.K.), Mayo Clinic, Rochester; and N. Bud Grossman Center for Memory Research and Care (K.A.V.), Department of Neurology, and Institute for Translational Neuroscience (K.A.V.), University of Minnesota, Minneapolis
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