Abstracts

Rationale: Prior research in healthy individuals has identified a three-factor structure for the Area Deprivation Index (ADI-3; Berg et al., Health Serv Outcomes Res Methodol. 2021;21:486 509), a measure of neighborhood disadvantage (Kind et al., N Engl J Med. 2018;378:2456). In the present study, we aim to replicate this factor structure in a clinical sample of individuals with epilepsy. Additionally, we examine how these distinct dimensions of deprivation are associated with demographic characteristics, clinical features, mood symptoms, and cognitive outcomes in a large TLE cohort.

Methods: Factor analysis was conducted to confirm the ADI-3 factor structure in a group of 1068 patients with pharmacoresistant epilepsy who were being evaluated for epilepsy surgery at Cleveland Clinic between 1986 and 2025. Clinical, demographic, and neuropsychological data were drawn from a comprehensive IRB-approved patient registry. Neuropsychological assessments included measures of general cognitive ability, verbal and nonverbal skills, attention/working memory, processing speed, verbal and visual memory, language, executive function, and self-reported symptoms of depression and anxiety. Linear regression analyses were used to examine the associations between the identified ADI-3 factors and clinical, sociodemographic, neuropsychological, and mood outcomes.

Results: Factor analysis identified three factors (Financial Strength, Economic Hardship and Inequality, and Educational Attainment) accounting for 71.13% of the variance with similar loadings previously described (Figure 1). Linear regression analyses revealed that the ADI-3 factors were associated with key sociodemographic and clinical factors, including lower educational attainment, non-White race, and presence of mesial temporal sclerosis, while specific factors such as Financial Strength and Educational Attainment showed distinct associations with age, race, education, and epilepsy-related variables. Higher Financial Strength and Educational Attainment were associated with better performance across multiple neuropsychological domains, particularly in reading, IQ, verbal comprehension, and working memory, with Financial Strength remaining a consistent predictor even after adjusting for clinical and sociodemographic factors; additionally, higher Financial Strength was linked to fewer depressive symptoms, while no ADI-3 factors were significantly associated with anxiety.

Conclusions: This study replicated the three-factor structure of the ADI-3 in a cohort of patients with epilepsy and found that these factors had distinct associations with demographic, clinical, cognitive, and mood outcomes. Financial Strength emerged as a robust predictor of cognitive performance and lower depressive symptoms, even after accounting for individual-level and clinical covariates. These findings highlight the value of analyzing specific components of neighborhood deprivation rather than a composite score, allowing for more targeted interventions and policy efforts to improve epilepsy outcomes.

Funding: Cleveland Clinic Epilepsy Center; Burroughs Wellcome Fund Postdoctoral Diversity Enrichment Program