Authors :
Presenting Author: Sabrina Tavella-Burka, DO – University of Virginia
Ifrah Zawar, MD – University of Virginia
Jaideep Kapur, MBBS, PhD – University of Virginia
Carrie McDonald, PhD – UCSD
Bruce Hermann, PhD – University of Wisconsin
Kayela Arrotta, PhD – Cleveland Clinic
Robyn Busch, PhD – Cleveland Clinic
Anny Reyes, PhD – Cleveland Clinic
Emily Johnson, MD – Johns Hopkins
Rani Sarkis, MD, MSC – Brigham and Women's Hospital, Harvard Medical School
Alice Lam, MD, PhD – Harvard
Vineet Punia, MD – Cleveland Clinic
Rationale: Despite high prevalence of cognitive decline in older people with epilepsy (PWE), the impact of epilepsy on judgment (i.e., routine decision-making) remains unexplored. We investigated the association of demographic, clinical, and epilepsy factors with judgment, as measured by the Test of Practical Judgment (TOPJ). We also evaluated the TOPJ’s associations with global cognition, cognitive domains, daily function, and quality of life in older PWE.
Methods:
Older PWE (≥ 55 years) were enrolled in the Brain Aging and Cognition in Epilepsy (BrACE) study at the Cleveland Clinic, the University of California San Diego, and the University of Wisconsin-Madison. The TOP-J has 9 questions with higher scores (range:0-27), indicating better judgment. A multivariable linear model was fitted with TOPJ as the dependent variable and age, sex, education, age of epilepsy onset, drug-resistant epilepsy, number of antiseizure medications, active epilepsy duration, and epilepsy localization as independent variables.
Pearson correlations examined the relationship between TOPJ and 1) global cognition Montreal Cognitive Assessment (MoCA) total score and cognitive profiles (intact vs impaired) according to the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE), 2) domain-specific MoCA subscores, letter fluency, Trail making, Multilingual Naming, animal fluency, 3) subjective cognitive function via everyday cognition (ECog: memory, language, visuospatial/perceptual abilities, executive function [planning]), 4) daily function (functional assessment questionnaire [FAQ]) and 5) quality of life in Epilepsy (QOLIE-31) scores. Benjamini-Hochberg false discovery rate correction was used for multiple comparisons.
Results:
Of 61 participants who completed the TOP-J (mean age=66.3 years, 57.4% female), average TOP-J score was 21.38 (Table 1). In the multivariable analysis, education was the only factor significantly associated with TOP-J. For each additional year of education, TOP-J score increased by 0.47 points.
After adjusting for age, sex, and education, higher total MoCA score was associated with higher TOP-J score (p=0.0063). After adjusting for age, sex, and education, patients in the IC-CoDE intact group had a 2.15-point higher TOP-J score (p=0.0120) than IC-CoDE impaired group.
For MoCA subscores, lower attention, language, and abstraction scores and worse letter fluency (executive function) and multilingual Naming (language) were associated with poorer TOP-J scores (Table 2). Worse TOP-J scores were also associated with poorer quality of life.
Conclusions: Our study shows that practical judgment may be impaired in older PWE (21.38 vs 23 in healthy controls), though this may be mitigated by higher education. Practical judgment is moderately correlated with global cognition and is most strongly associated with executive function, language and poor quality of life. Reduced judgment should be considered in older PWE demonstrating cognitive impairment. For such patients, TOP-J may serve as an effective screening tool and help connect older PWE to support services to address these individuals' risks and needs.
Funding:
BRACE(5R01NS120976), AAIC:AACSFD-22-974008), AES:1067206),1K23AG084893-01A1