Comorbid depression among patients with epilepsy who also have cognitive impairment results in poorer functional status and increased mortality, according to findings presented at the American Academy of Neurology Annual Meeting (AAN). Rohit Marawar, MD, and colleagues examined data from the United States National Alzheimer’s Coordinating Center (NACC) Uniform Data Set. Specifically, they studied patients with mild cognitive impairment or dementia and seizures within the previous year. The re – searchers defined active depression as depression in the previous 2 years. Outcome measures included Functional Assessment Questionnaire (FAQ) Score, Clinical Dementia Rating-Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE) score, and mortality.
Influence of Active Depression
The analysis included 642 participants who had both cognitive impairment and active seizures during the study period. More than half (n=342; 53.3%) had active depression; these participants were younger than those without active depression ( P=0.01). Dr. Marawar and colleagues found that the coexistence of active depression was associated with a higher FAQ score (OR, 2.76; P=0.01) and mortality (OR, 1.46; P=0.02). The re – searchers also determined that patients with cognitive impairment who had active seizures and depression had higher CDR-SB scores and lower MMSE scores than participants without depression, but those results were not statistically significant.
Far-Reaching Implications of AAN Results
Previous studies, as well as additional findings presented at AAN, indicate that the results from Dr. Marawar and colleagues have the potential to impact many patients with epilepsy. In a study published in Neurology, Andres M. Kanner, MD, and colleagues showed that nearly half of patients with newly diagnosed epilepsy met criteria for at least one mood and/ or anxiety disorder; these disorders were also linked with increased symptoms of suicidality. A separate study from Robyn Busch, PhD, and coinvestigators examined the relationship between cognitive phenotype and psychiatric symptoms in patients with epilepsy. This study showed that moderate or severe depression increased the odds of a worse cognitive phenotype compared with minimal depression. Finally, another presentation at AAN indicated that seizure activity may be associated with both improvements in and worsening of mood, as measured by depression indexes. “Effective screening and management of depression in [patients with epilepsy and cognitive impairment] is essential,” Dr. Marawar and colleagues wrote.
