Cognition and epilepsy: Cognitive screening test

Tedrus, Glória Maria Almeida Souza; Passos, Maria Lina Giacomino Almeida; Vargas, Letícia Muniz; Menezes, Larissa Estela Ferreira Jacó

doi:10.1590/1980-57642020dn14-020013

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 14 (2) • Apr-Jun 2020 • https://doi.org/10.1590/1980-57642020dn14-020013 copy

Cognition and epilepsy: Cognitive screening test

COGNIÇÃO E EPILEPSIA: TESTE DE TRIAGEM COGNITIVA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Cognitive deficits often occur in people with epilepsy (PWE). However, in Brazil, PWE might not undergo neurocognitive evaluation due to the low number of validated tests available and lack of multidisciplinary teams in general epilepsy outpatient clinics.

Objective:

To correlate Brief Cognitive Battery-Edu (BCB-Edu) scores with epilepsy characteristics of 371 PWE.

Methods:

Clinical and cognitive assessment (MMSE, BCB-Edu) of 371 PWE aged >18 years was performed. The clinical aspects of epilepsy were correlated with BCB-Edu data. Cognitive data of PWE were compared against those of 95 healthy individuals (NC), with p-<0.05.

Results:

People with epilepsy had lower cognitive performance than individuals in the NC group. Cognitive aspects also differed according to epilepsy characteristics. Predictive factors for impairment in multiple cognitive domains were age and use of more than one antiepileptic drug (logistic regression; R² Nagelkerke=0.135).

Conclusion:

Worse cognitive performance was found in PWE on different domains. There was a relationship between cognitive impairment and the aspects of epilepsy. BCB-Edu proved to be effective as a cognitive assessment screening test for epilepsy in adults.

Key words:
epilepsy; Brief Cognitive Battery-Edu; cognition

	Genetic	Focal unknown etiology	Focal structural	p
Sex: Female/ Male	13/9	58/63	110/190	0.607^a a Chi-square test;
Age (years)	28.5 (±12.1)	47.2 (±16)	51.3 (±15.8)	<0.000^b b Kruskall-Wallis; ^* * p<0.05.
Age at onset (years)	14 (±3.7)	26.1 (±19.7)	28.6 (±21.8)	0.039^b b Kruskall-Wallis; ^* * p<0.05.
Antiepileptic drugs: 1/ ≥2	18/4	86/35	133/95	0.012^a a Chi-square test; ^* * p<0.05.
Seizure frequency: with seizure / controlled	7/15	48/73	96/132	0.619^a a Chi-square test;
EA laterality: right/ left	-	42/49	84/101	0.963^a a Chi-square test;

		PWE (n=371)	NC (n=95)	P	TLE-HS (n=113)	NC (n=95)	p	Epileptic syndrome
		PWE (n=371)	NC (n=95)	P	TLE-HS (n=113)	NC (n=95)	p	Genetic	Unknown etiology	Structural	p
Age (years)		48.6 (±16.5)	48.5 (±10.4)	0.164^a a t-test;	48.3 (±13.4)	48.5 (±10.4)	0.881^a a t-test;	28.5 (±12.1)	47.2 (±16.0)	51.3 (±15.8)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
Educational level (years)		5.7 (±3.8)	6.4 (±3.3)	0.074^a a t-test;	5.5 (±3.5)	6.4 (±3.3)	0.029^* * p<0.05. ^a a t-test;	8.6 (±3.4)	6.5 (±3.5)	5.0 (±3.8)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
MMSE		23.1 (±4.1)	24.7 (±2.6)	<0.001^* * p<0.05. ^a a t-test;	22.8 (±4.5)	24.7 (±2.6)	<0.001^* * p<0.05. ^a a t-test;	25.1 (±3.8)	24 (±3.3)	22.5 (±4.4)	0.002^* * p<0.05. ^b b Kruskall-Wallis;
BCB-Edu	• Identification	9.8 (±0.7)	9.9 (±0.2)	0.005^* * p<0.05. ^a a t-test;	9.9 (±0.2)	9.9 (±0.2)	0.723^a a t-test;	10.0 (±0.0)	9.8 (±0.7)	9.8 (±0.8)	0.370^b b Kruskall-Wallis;
	- Naming	9.7 (±1.0)	9.8 (±0.5)	0.173^a a t-test;	9.8 (±0.3)	9.8 (±0.5)	0.423^a a t-test;	10.0 (±0.0)	9.8 (±0.7)	9.6 (±1.2)	0.094^b b Kruskall-Wallis;
	• Incidental memory	5.8 (±1.8)	6.1 (±1.6)	0.086^a a t-test;	5.8 (±1.6)	6.1 (±1.6)	0.276^a a t-test;	6.4 (±1.8)	6.0 (±1.7)	5.6 (±1.8)	0.045^* * p<0.05. ^b b Kruskall-Wallis;
	• Immediate memory	7.3 (±1.9)	8.2 (±1.4)	<0.001^* * p<0.05. ^a a t-test;	7.3 (±1.8)	8.2 (±1.4)	<0.001^* * p<0.05. ^a a t-test;	8.7 (±1.1)	7.5 (±1.8)	7.0 (±1.9)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
	- Learning test	7.7 (±1.9)	8.9 (±1.1)	<0.001^* * p<0.05. ^a a t-test;	7.7 (±1.7)	8.9 (±1.1)	<0.001^* * p<0.05. ^a a t-test;	8.6 (±1.8)	8.2 (±1.7)	7.4 (±2.0)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
	- Delayed recall	6.7 (±2.1)	8.1 (±1.5)	<0.001^* * p<0.05. ^a a t-test;	6.7 (±1.9)	8.1 (±1.5)	<0.001^* * p<0.05. ^a a t-test;	8.0 (±1.7)	7.0 (±2.0)	6.4 (±2.2)	0.003^* * p<0.05. ^b b Kruskall-Wallis;
	- Recognition	9.1 (±1.6)	9.6 (±1.1)	<0.001^* * p<0.05. ^a a t-test;	9.3 (±1.2)	9.6 (±1.1)	0.037^* * p<0.05. ^a a t-test;	9.6 (±0.7)	9.2 (±1.4)	8.9 (±1.8)	0.031^* * p<0.05. ^b b Kruskall-Wallis;
Clock Drawing Test		5.6 (±2.8)	6.9 (±2.5)	<0.001^* * p<0.05. ^a a t-test;	5.7 (±2.7)	6.9 (±2.5)	0.001^* * p<0.05. ^a a t-test;	7.3 (±2.6)	6.0 (±2.5)	5.1 (±2.9)	0.001^* * p<0.05. ^b b Kruskall-Wallis;
SVF test		11.2 (±4.8)	12 (±4.8)	0.173^a a t-test;	10.7 (±4.3)	12 (±4.8)	0.045^* * p<0.05. ^a a t-test;	12.7 (±5.1)	12.3 (±4.8)	10.5 (±4.6)	0.001^* * p<0.05. ^b b Kruskall-Wallis;
PVF (F)		4.9 (±3.9)	7.7 (±5.4)	<0.001^* * p<0.05. ^a a t-test;	4.4 (±3.0)	7.7 (±5.4)	<0.001^* * p<0.05. ^a a t-test;	5.6 (±3.6)	5.7 (±4.2)	4.5 (±3.7)	0.020^* * p<0.05. ^b b Kruskall-Wallis;
PVF (A)		4.3 (±3.5)	7.0 (±4.7)	<0.001^* * p<0.05. ^a a t-test;	3.9 (±2.7)	7.0 (±4.7)	<0.001^* * p<0.05. ^a a t-test;	4.5 (±3.9)	5.2 (±3.7)	3.8 (±3.3)	0.003^* * p<0.05. ^b b Kruskall-Wallis;
PVF (S)		4.2 (±3.5)	7.2 (±5.1)	<0.001^* * p<0.05. ^a a t-test;	3.8 (±2.6)	7.2 (±5.1)	<0.001^* * p<0.05. ^a a t-test;	5.1 (±3.9)	5.0 (±3.8)	3.8 (±3.1)	0.024^* * p<0.05. ^b b Kruskall-Wallis;

		No cognitive impairment (n=133)	Impairment in multiple cognitive domains (n=238)	p-value
Age (years)		44.1 (±15.0)	51.1 (±16.9)	<0.001^* * p<0.05. ^a a t-test;
Educational level (years)		6.8 (±3.6)	5.0 (±3.7)	<0.001^* * p<0.05. ^a a t-test;
Age at onset (years)		23.2 (±15.9)	28.9 (±22.6)	0.005^* * p<0.05. ^a a t-test;
Duration of epilepsy (years)		20.9 (±15.3)	22.2 (±17.1)	0.459^a a t-test;
Sex	Female	76 (41.9%)	105 (58%)	0.016^* * p<0.05. ^b b Fisher's exact test;
Sex	Male	57 (30%)	133 (70%)
Antiepileptic drugs	1	94 (70.6%)	39 (29.3%)	0.042^* * p<0.05. ^b b Fisher's exact test;
Antiepileptic drugs	≥2	143 (60%)	95 (39.9%)
Epileptic syndrome	Genetic	12 (54.5%)	10 (45.4%)	0.002^* * p<0.05. ^c c Chi-square test;
	Focal unknown etiology	55 (45.4%)	66 (55.4%)
	Focal structural	66 (28.9%)	162 (71%)
Epilepsy	TLE-HS (113)	39 (34.5%)	74 (65.4%)	0.037^* * p<0.05. ^c c Chi-square test;
Epilepsy	Unknown etiology and genetic	68 (47.5%)	75 (52.4%)
TLE-HS laterality	Right (n=50)	20 (40%)	30 (60%)	0.261^b b Fisher's exact test;
TLE-HS laterality	Left (n=56)	18 (32.1%)	38 (67.8%)

		Age		Age at onset		Duration of epilepsy
		Correlation	p-value	Correlation	p-value	Correlation	p-value
MMSE		-0.190	<0.001^* * p<0.05.	-0.012	0.822	-0.174	0.001^* * p<0.05.
BCB-Edu	Identification	-0.155	0.003^* * p<0.05.	-0.098	0.061	-0.032	0.542
	Naming	-0.170	0.001^* * p<0.05.	-0.122	0.019^* * p<0.05.	-0.017	0.743
	Incidental memory	-0.388	<0.001^* * p<0.05.	-0.291	<0.001^* * p<0.05.	-0.029	0.573
	Immediate memory	-0.345	<0.001^* * p<0.05.	-0.185	<0.001^* * p<0.05.	-0.115	0.028^* * p<0.05.
	Learning test	-0.308	<0.001^* * p<0.05.	-0.218	<0.001^* * p<0.05.	-0.035	0.506
	Delayed recall	-0.231	<0.001^* * p<0.05.	-0.190	<0.001^* * p<0.05.	0.004	0.943
	Recognition	-0.308	<0.001^* * p<0.05.	-0.223	<0.001^* * p<0.05.	-0.031	0.548
Clock Drawing Test		-0.220	<0.001^* * p<0.05.	-0.069	0.200	-0.133	0.013^* * p<0.05.
SVF test		-0.180	<0.001^* * p<0.05.	-0.099	0.058	-0.060	0.254
PVF (F)		-0.119	0.023^* * p<0.05.	-0.002	0.965	-0.118	0.025^* * p<0.05.
PVF (A)		-0.064	0.223	-0.007	0.894	-0.058	0.273
PVF (S)		-0.101	0.053	-0.016	0.756	-0.082	0.121

Test	Variables in equation	Beta coefficient	SE	95% CI for coefficient	p
Immediate memory^a a R2 Nagelkerke=0.130;	Age	0.035	0.011	1.015 1.057	0.001*
Immediate memory^a a R2 Nagelkerke=0.130;	Educational level (years)	-0.091	0.046	0.825 0.999	0.047*
Learning test^b b R2 Nagelkerke=0.119;	Age	0.027	0.010	1.008 1.047	0.005*
Learning test^b b R2 Nagelkerke=0.119;	Educational level (years)	-0.104	0. 042	0.830 0.978	0.013*
Delayed recall^c c R2 Nagelkerke=0.109;	Educational level (years)	-0.114	0.036	0.831 0.958	0.002*
	Age at onset	0.015	0.006	1.003 1.027	0.017*
	AED: 1/ ≥2	-0.785	0.268	0.270 0.771	0.003*
Recognition^d d R2 Nagelkerke=0.124;	Age	0.030	0.010	1.011 1.052	0.003*
Recognition^d d R2 Nagelkerke=0.124;	Educational level (years)	-0.102	0.045	0.827 0.986	0.022*
SVF test^e e R2 Nagelkerke=0.169;	Educational level (years)	-0.186	0.032	0.780 0.884	<0.001*
SVF test^e e R2 Nagelkerke=0.169;	AED: 1/ ≥2	-0.740	0.255	0.289 0.787	0.004*
Impairment in multiple cognitive domains ^f f R2 Nagelkerke =0.072.	Age	0.026	0.006	1.007 1.046	0.006*
	AED: 1/ ≥2	-0.628	0.285	0.035 0.934	0.028*

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