Abstracts

Rationale: This study aimed to determine the accuracy of epilepstic patient's self reports and physician's clinical judgement in rating/assessing cognitive status as compared to objective, computerized neuropsychological screeing.Methods: We conducted a retrospective review of data for 91 consecutive patients with Epilepsy who were referred to the South Shore Neurologic Epilepsy Center (4 neurologists and one nurse practitioner) for management of seizures. As part of their clinical assessment patients were given a QOL inventory (QOL-31P), which includes assessment of functional status, physical, emotional and cognitive functionoing. Patient's perception of cognitive impairment was determined by their reports on the ""cognitive questions"" of the QOL-31P. The patient's physicians were also asked to rate the patient's cognitive status on a likert-type scale (none, mild, moderate or severe). The patients in the study also underwent a cognitive screening with Mindstrem's Neurotrax for objective assessment of their cognitive functioning.Results: The three different ratings/results of physician perception, patient self-perception of cognition, and Neurotrax total score were normalized using z-squared normalization. SAS statistical package was then used to determine the Pearson-r correlations between the 3 measures. It was determined that there was a significant, moderate/stronger correlation between clinician perception of cognitive impairment and patient self-assessment of cognitive impairment (r=.4; P<0.01). It was further determined that patients perception of the cognitive functioning was also significantly, moderately correlated with their objective performance on Neurotrax (r=.36; P<0.01). Finally, it was determined that physicians rating of cognitive functioning was significant but only mildly positively correlated with objective cognitive results (r=.29; P<0.01).Conclusions: Epilepsy is a chronic condition that has complex effects on physical, cognitive, social, vocational, and psychological functions. Physicians often rely on their clinical perception or the patient's self reports to define the patient's cognitive status. This study has revealed that the accuracy of both the patients and physician's appraisal of cognitive status can be limited and likely influenced by a variety of factors. These results would argue that in high-risk populations, such as patients with epilepsy, cognitive screening would be more reasonably applied on a routine basis to minimize patient and physician bias in defining cognitive functioning/status. With appropriate data regarding objective cognitive status, physicians can be better equipped to assess functioning over time, better determine the impact of interventions that are provided on the patient's cognitive functioning and be more prepared to define which patients would benefit from more comprehensive cognitive assessments and interventions to address cognitive difficulties that are often associated with neurologic conditiions such as epilepsy.