Abstracts

Rationale: Cerebrovascular risk factors (CVRFs) and comorbid disease (stroke, cardiovascular, metabolic, or inflammatory disease) have been linked to cognitive impairments in epilepsy and other neurological disorders; however, very little is known as to whether these co-morbidities increase the risk of post-operative cognitive decline. In this study, we explored the effects of CVRFs and comorbid diseases on postoperative decline in language and verbal memory in patients with left temporal lobe epilepsy (LTLE).  Methods: Twenty-one patients with LTLE underwent pre- and 1-year postsurgical neuropsychological testing. Measures of language included visual (BNT) and auditory (ANT) naming and category fluency (CF). Measures of verbal memory included immediate and delayed recall from the CVLT-II and WMS-III Logical Memory (LM) and Verbal Paired Associates (VPA). History (Hx) or current diagnosis of cardiovascular and metabolic disorders were obtained. CVRFs included pulse pressure proxy (PPP), body mass index (BMI) and fasting glucose. Correlation analyses were conducted to evaluate the relationship between CVRFs and reliable change indices (RCIs) for each cognitive measure. Stepwise regressions were conducted to evaluate the contribution of clinical variables, Hx of vascular/metabolic disease and CVRFs to RCIs. Results: Mean age at surgery was 30.71 years old, mean duration of disorder= 16.45 years, and 61.9% of the patients were female. Fourteen percent of patients had a history significant for cardiovascular disease and 10% for metabolic disorders. Sixty-two percent of patients had a BMI in the healthy range, 33% were overweight, and 5% were obese. From 19-42% of patients demonstrated postoperative decline across the language measures, 39-65% across measures of immediate memory, and 23-44% across delayed memory indices. Table 1 demonstrates correlations between CVRFs and RCI-PE. Higher BMI was associated with decline in verbal memory and language, and higher glucose was associated with decline in verbal memory. Table 2 demonstrates the significant predictors of language and verbal memory decline. Overall, elevated CVRFs and history of vascular and/or metabolic conditions explained 27-42% of the variance in language scores and 21-53% of the variance in memory scores. Conclusions: Elevated CVRFs and co-morbid conditions were associated with postoperative language and verbal memory decline in patients with LTLE. In particular, BMI seems to play an important role, with higher BMI increasing risk for cognitive decline across multiple measures of verbal memory. These findings suggest that targeted patient interventions may benefit from the inclusion of modifiable health related risk factors that may reduce the risk of postoperative cognitive decline. Funding: AR 1F31NS111883-01CRM R01 NS065838