For people with epilepsy, neighborhood may be tied to memory, mental health
MINNEAPOLIS – People with epilepsy living in disadvantaged neighborhoods—areas with higher poverty levels and fewer educational and employment opportunities— may be more likely to have memory, thinking, and mental health problems compared to people with epilepsy living in neighborhoods with fewer disadvantages, according to new research published in the April 19, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study does not prove that living in disadvantaged neighborhoods causes memory and mental health problems. It only shows an association.
“Epilepsy research has arguably ignored the potential impact of the social determinants of health in neighborhoods on cognition—factors that have been hiding in plain sight for many years,” said study author Robyn Busch, PhD, of Cleveland Clinic in Ohio. “Our study shows that these neighborhood social factors are linked to epilepsy outcomes.”
For the study, researchers reviewed a registry of people with temporal lobe epilepsy, the most common adult form of epilepsy, which is associated with high risk for thinking problems and depressed mood. Researchers identified 800 people with an average age of 38 whose epilepsy was resistant to treatment and who were evaluated for potential epilepsy surgery.
Researchers compared the participants’ scores on measures of intelligence, attention, memory and other thinking skills, depression and anxiety.
Researchers used the home address of each participant and a measure called the Area Deprivation Index to determine if each participant lived in an advantaged or disadvantaged neighborhood. The index incorporates information on the socioeconomic conditions of each neighborhood and its residents, ranking neighborhoods based on 17 indicators including income, employment, education and housing quality. Neighborhoods in the index are determined by census areas of about 1,500 residents.
Researchers divided participants into five groups based on neighborhood advantage.
In a composite score of all attention tests, with scores ranging from 60 to 135, people in neighborhoods with the most disadvantage had an average score of 85 compared to those in neighborhoods with the least disadvantage who had an average score of 95. Higher scores indicate better attention. Similar results were seen on measures of intelligence, processing speed, language, visuospatial skills, and memory, with people in the most disadvantaged neighborhoods showing lower test scores than those in less disadvantaged neighborhoods.
When compared to people in neighborhoods with the least disadvantage, people in neighborhoods with the most disadvantage were more likely to have worse cognitive outcomes across tests of different thinking skills. People who self-identified as Black, Hispanic or from other non-white groups were overrepresented in the most disadvantaged neighborhood group and were nearly three times more likely to have reduced scores on multiple cognitive tests than non-Hispanic white people.
Based on their self-reported symptoms, people in neighborhoods with the most disadvantage reported mild symptoms of depression and anxiety compared to those in neighborhoods with the least disadvantage who reported minimal symptoms of depression and anxiety.
“These study findings elevate the need to consider the role of social and neighborhood issues in assessing the outcomes for people with epilepsy,” said editorial author Lidia M. V. R. Moura, MD, MPH, PhD of Massachusetts General Hospital in Boston and Fellow of the American Academy of Neurology. “More research is needed to identify these social factors that may be modifiable that can help improve cognition and prevent further worsening. More community-based partnerships and the usage of screening and mapping tools may help reduce these disparities among people with epilepsy.”
A limitation of the study was that Area Deprivation Index scores were measured at only one point in adulthood. This does not include neighborhood information during critical periods of early development or changes throughout life.
The study was supported by the Cleveland Clinic Epilepsy Center.
Learn more about epilepsy at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
Simple test may predict cognitive impairment long before symptoms appear
Peer-Reviewed Publication MINNEAPOLIS – In people with no thinking and memory problems, a simple test may predict the risk of developing cognitive impairment years later, according to a study published in the April 19, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“There is increasing evidence that some people with no thinking and memory problems may actually have very subtle signs of early cognitive impairment,” said study author Ellen Grober, PhD, of Albert Einstein College of Medicine in the Bronx, New York. “In our study, a sensitive and simple memory test predicted the risk of developing cognitive impairment in people who were otherwise considered to have normal cognition.”
The study involved 969 people with an average age of 69 with no thinking or memory problems at the start of the study. They were given a simple memory test and were followed for up to 10 years.
The test includes two phases. For the study phase, people are shown four cards, each with drawings of four items. They are asked to identify the item belonging to a particular category. For example, participants would name the item “grapes” after being asked to identify a “fruit.” For the test phase, participants are first asked to recall the items. This measures their ability to retrieve information. Then, for items they did not remember, they are given category cues. This phase measures memory storage.
The participants were divided into five groups, or stages zero through four, based on their test scores, as part of the Stages of Objective Memory Impairment (SOMI) system. Stage zero represents no memory problems. Stages one and two reflect increasing difficulty with retrieving memories which can precede dementia by five to eight years. These participants continue to be able to remember items when given cues. In the third and fourth stages, people cannot remember all the items even after they are given cues. These stages precede dementia by one to three years.
A total of 47% of the participants were in stage zero, 35% in stage one, 13% in stage two and 5% in stages three and four combined.
Of the participants, 234 people developed cognitive impairment.
After adjusting for age, sex, education and a gene that affects a person’s risk of Alzheimer’s disease, APOE4, researchers found when compared to people who were at SOMI stage zero, people at stages one and two were twice as likely to develop cognitive impairment. People who were at stages three and four were three times as likely to develop cognitive impairment.
After adjusting for biomarkers of Alzheimer’s disease including brain amyloid plaques and tau tangles, the SOMI system continued to predict an increased risk of cognitive impairment.
Researchers estimated that after 10 years about 72% of those in the third and fourth stages would have developed cognitive impairment, compared to about 57% of those in the second stage, 35% in the first stage and 21% of those in stage zero.
“Our results support the use of the SOMI system to identify people most likely to develop cognitive impairment,” said Grober. “Detecting cognitive impairment at its earliest stages is beneficial to researchers investigating treatments. It also could benefit those people who are found to be at increased risk by consulting with their physician and implementing interventions to promote healthy brain aging.”
A limitation of the study was that most participants were white and well educated. Grober said more research is needed in larger and more diverse populations.
The study was funded by the National Institutes of Health, Alzheimer’s Association, Cure Alzheimer Fund and the Leonard and Sylvia Marx Foundation.
Learn more about brain health at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.
MINNEAPOLIS – In people with no thinking and memory problems, a simple test may predict the risk of developing cognitive impairment years later, according to a study published in the April 19, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“There is increasing evidence that some people with no thinking and memory problems may actually have very subtle signs of early cognitive impairment,” said study author Ellen Grober, PhD, of Albert Einstein College of Medicine in the Bronx, New York. “In our study, a sensitive and simple memory test predicted the risk of developing cognitive impairment in people who were otherwise considered to have normal cognition.”
The study involved 969 people with an average age of 69 with no thinking or memory problems at the start of the study. They were given a simple memory test and were followed for up to 10 years.
The test includes two phases. For the study phase, people are shown four cards, each with drawings of four items. They are asked to identify the item belonging to a particular category. For example, participants would name the item “grapes” after being asked to identify a “fruit.” For the test phase, participants are first asked to recall the items. This measures their ability to retrieve information. Then, for items they did not remember, they are given category cues. This phase measures memory storage.
The participants were divided into five groups, or stages zero through four, based on their test scores, as part of the Stages of Objective Memory Impairment (SOMI) system. Stage zero represents no memory problems. Stages one and two reflect increasing difficulty with retrieving memories which can precede dementia by five to eight years. These participants continue to be able to remember items when given cues. In the third and fourth stages, people cannot remember all the items even after they are given cues. These stages precede dementia by one to three years.
A total of 47% of the participants were in stage zero, 35% in stage one, 13% in stage two and 5% in stages three and four combined.
Of the participants, 234 people developed cognitive impairment.
After adjusting for age, sex, education and a gene that affects a person’s risk of Alzheimer’s disease, APOE4, researchers found when compared to people who were at SOMI stage zero, people at stages one and two were twice as likely to develop cognitive impairment. People who were at stages three and four were three times as likely to develop cognitive impairment.
After adjusting for biomarkers of Alzheimer’s disease including brain amyloid plaques and tau tangles, the SOMI system continued to predict an increased risk of cognitive impairment.
Researchers estimated that after 10 years about 72% of those in the third and fourth stages would have developed cognitive impairment, compared to about 57% of those in the second stage, 35% in the first stage and 21% of those in stage zero.
“Our results support the use of the SOMI system to identify people most likely to develop cognitive impairment,” said Grober. “Detecting cognitive impairment at its earliest stages is beneficial to researchers investigating treatments. It also could benefit those people who are found to be at increased risk by consulting with their physician and implementing interventions to promote healthy brain aging.”
A limitation of the study was that most participants were white and well educated. Grober said more research is needed in larger and more diverse populations.
The study was funded by the National Institutes of Health, Alzheimer’s Association, Cure Alzheimer Fund and the Leonard and Sylvia Marx Foundation.
Learn more about brain health at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.
JOURNAL
Neurology
Neurology
No comments:
Post a Comment