Abstracts

Rationale: Patients with neurocognitive deficits frequently report impairment in activities of daily living (ADLs); however, few studies have formally investigated the type and severity of ADL dysfunction in patients with epilepsy. Based on studies of patients with dementia that show a relationship between everyday functioning and cognitive dysfunction, it would be expected that there would be deficits in cognitively-based daily living skills in patients with circumscribed lesions. The purpose of this study was to compare the performance of patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) on cognitively-based daily living tasks. It was hypothesized that patients with TLE would demonstrate relatively more impairment on a test of everyday memory, while patients with FLE would demonstrate relatively more impairment on a test of executive functioning than on daily living tests measuring other cognitive domains. Methods: Twenty-four patients with TLE (58.3% female) and nine patients with FLE (44.4% female) underwent comprehensive neuropsychological testing as part of their pre-operative evaluation. The mean age of the TLE subjects was 36.3 ± 8.7 years, mean educational level was 14.1 ± 2.7 years, and mean seizure duration was 23.7 ± 11.9 years. The mean age of the FLE subjects was 33.3 ± 10.9 years, mean educational level was 12.9 ± 2.2 years, and mean seizure duration was 16.8 ± 12.6 years. The two groups were matched on all demographic variables. Subjects were administered the five Daily Living subtests of the Neuropsychological Assessment Battery (NAB). The NAB Daily Living subtests provide assessment of five functional domains [Attention, Executive Function, Language, Spatial, and Memory-Delayed Recall (Mem-DR)] that are highly congruent with analogous real-world behavior and serve as proxy measures for daily functioning. Results: The TLE group showed significant impairments on daily living tests of Memory and Attention while the FLE group showed significant impairments in Memory and Language. Non-parametric tests were used to compare the groups on the NAB subtests. There were no significant differences observed between TLE and FLE groups on any of the Daily Living subtests. Conclusions: Contrary to our expectation, the TLE and FLE patient groups did not demonstrate a double dissociation in memory and executive daily functioning. Rather, both groups were significantly impaired in daily memory functioning, while their executive daily functioning test scores were within normal limits. Relative deficits were also noted in attention in the TLE group and language in the FLE group, suggesting that despite having focal lesions, functional impairments may be seen in a broad range of daily activities in these patient groups. Future studies are needed with larger sample sizes to better understand how cognitive impairment in epilepsy is associated with deficits in daily living.