Clinical Evidence Of Ad And Epilepsy Co
AD is an important cause of senile epilepsy. Increased AD duration is associated with a higher risk of epilepsy . In addition, the risk of epilepsy in patients with AD is 10 times higher than that of individuals without AD in people over the age of 65 years . Horvath et al. conducted a 3-year prospective follow-up study that included yearly cognitive assessments on 38 patients with AD and 20 healthy individuals and found that subclinical epileptiform discharges were recorded more frequently in patients with AD than in healthy, elderly individuals. Subclinical epileptiform activity was also observed in patients with amnestic mild cognitive impairment or early AD . Patients with familial early-onset AD have a higher risk of having seizures . Haoudy et al. studied 25 patients with early onset AD and positive cerebrospinal fluid AD biomarkers. Based on epilepsy expert consultation and EEG examination, the results showed that 10 of these patients had epilepsy.
Antiseizure Medications That Worsen Cognitive Performance And Dementia
ASMs are increasingly used in the elderly not only for treatment of epilepsy but also for management of psychiatric diseases, neuropathic pain, and behavioral disorders observed in dementia with a special regard for AD . It has been an object of debate if use of ASMs in the geriatric population, notoriously more susceptible to drugs adverse effects in reason of age-related altered pharmacodynamics, polytherapy, and comorbidities, could represent a predisposing factor for dementia itself. Currently only two studies have explored this correlation. The first one is a case-control study of Carter and colleagues who analyzed a cohort of more than 5,000 elderly subjects with a five-year follow-up period and concluded that people reporting ASMs use at baseline had an overall odds ratio of 2.11 for developing dementia compared to controls. Taipale et al. taking into consideration the same topic found a less strong correlation in a German and Finnish population analyzed with a lag time of two years between ASM use and dementia diagnosis with a higher risk for drugs associated to known cognitive adverse effects . Anyway, these studies have been criticized by scientific community for their methodological approach , thus still leaving unsolved the question whether ASMs could directly cause dementia.
Table 1
Reviewon The Relationships Between Epilepsy Sleep And Alzheimers Disease: A Narrative Review
Epilepsy, sleep, and Alzheimers disease are tightly interconnected.
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Epileptiform activity and sleep disorders are both highly prevalent in Alzheimers disease.
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The treatment of modifiable risk factors such as epilepsy and sleep disturbances is important in Alzheimers disease.
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Slow-wave sleep is essential for memory consolidation and might present a therapeutical target in Alzheimers disease.
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Enhancement of slow-wave sleep must take into consideration the possible increase of epileptiform activity.
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Can Seizures Be Managed In People With Dementia
There is good news. There are medicines that are effective at reducing, and hopefully stopping, epileptic seizures.
If you think that you or someone you know with dementia may be having epileptic seizures, you should tell a doctor. They might want to perform some extra tests and may want to start some extra medicines to treat this problem.
What we dont know yet is whether starting treatment for epilepsy might help to slow down dementia and whether it might help keep peoples memory function better for longer.
Disease Duration And Seizure Prevalence
The effect of disease duration on seizure prevalence was highly significant in patients with AD dementia . The frequency of active seizures amounted to 1.51% after 4.8 years of AD dementia duration and increased to 5.43% at 11.0 years of disease course. On average, prevalence of active seizures in AD dementia rose by 0.64% per year of disease duration .
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Who Might Be Affected By Seizures
For a long time, researchers believed epileptic seizures occurred only in people who had long been diagnosed with dementia. It was thought they were a reflection of how much the brain had changed and shrunk because of it.
However, more recent research has suggested that seizures can occur early-on in Alzheimers disease. In some people, seizures may happen even before memory problems become apparent.
As part of my research, I recruited people from the local memory clinic here in Exeter. We asked them questions about epilepsy.
What To Do About Body Jerking
Sudden twitching or jerking, known as myoclonus, is another condition that sometimes happens with Alzheimer’s. The person’s arms, legs, or whole body may jerk. This can look like a seizure, but the person doesn’t pass out. Tell the doctor right away if you see these signs. The doctor may prescribe one or more medicines to help reduce symptoms.
Read about this topic in Spanish. Lea sobre este tema en español.
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Provide Support For Family And Friends
Keep any family or friends informed about what is happening in a gentle, sensitive and supportive way. This will help reassure them that the person is getting the care they need. You could consider signposting them to appropriate services, such as an Admiral Nurse or local Alzheimers Society. It can also help to give them an opportunity to talk about what is happening.
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Gallagher has been putting this theory to the test in clinical trials. A short phase 2 trial completed in 2017 used a common anti-seizure drug called levetiracetam and measured reduced activity in the hippocampus of test subjects coupled with improved performance on memory tests.
Gallagher started a company, AgeneBio, that is now recruiting 830 subjects for a phase 3 clinical trial using a specially formulated low-dose version of the drug. Patients with the type of mild cognitive impairment that precedes Alzheimers will take the drug for a year and a half to crank down the neural activity, said Gallagher, and see whether the disease progresses more slowly. Three smaller phase 2 trials using a similar strategy are also underway, sponsored by the Medical College of Wisconsin, University of Minnesota, University of San Francisco, and Oxford University Hospitals.
Mucke, like Gallagher and many other neuroscientists, believes that the phenomenon of hyperactivity is ripe for the discovery of additional therapeutic entry points that might not only be symptomatically beneficial but also have the potential to be disease-modifying. He points out that brain rhythms have a strong impact on immune system function in the brain, which is increasingly implicated in the pathogenesis of Alzheimers disease.
So, if we do establish that this is an early sign, one thing that I would be very interested in evaluating, said Keret, is whether interventions at this stage are successful.
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What Are The Average Life Expectancy Figures For The Most Common Types Of Dementia
The average life expectancy figures for the most common types of dementia are as follows:
- Alzheimers disease around eight to 10 years. Life expectancy is less if the person is diagnosed in their 80s or 90s. A few people with Alzheimers live for longer, sometimes for 15 or even 20 years.
- Vascular dementia around five years. This is lower than the average for Alzheimers mostly because someone with vascular dementia is more likely to die from a stroke or heart attack than from the dementia itself.
- Dementia with Lewy bodies about six years. This is slightly less than the average for Alzheimers disease. The physical symptoms of DLB increase a persons risk of falls and infections.
- Frontotemporal dementia about six to eight years. If a person has FTD mixed with motor neurone disease a movement disorder, their dementia tends to progress much quicker. Life expectancy for people who have both conditions is on average about two to three years after diagnosis.
To find out about the support available to someone at the end of their life, and to their carers, family and friends, see our End of life care information.
You can also call Alzheimers Society on 0333 150 3456 for personalised advice and support on living well with dementia, at any stage.
Dementia Connect support lineDementia Connect support line.
Molecular Links Between Epilepsy And Dementia In Older Patients
Another possible explanation for the increased risk of dementia in epilepsy is that some dementia syndromes might also share underlying pathological mechanisms with epilepsy, or that seizures might trigger pathological changes that make the brain more vulnerable to developing dementia pathology. Limited histopathological work has been performed to better delineate these aspects. In their study examining 138 people with chronic epilepsy, found that there was a higher incidence of cerebrovascular disease in older patients, and a significant correlation with cerebrovascular disease and higher Braak stages of Alzheimers disease-type pathology. However, when age was factored out, the association between cerebrovascular disease and Braak stage was no longer significant . Importantly in this cohort of patients, 30% had evidence of traumatic brain injury and this, rather than the number of seizures, correlated with a higher Braak stage . Similarly it has long been recognized that traumatic brain injury can increase the rate of dementia . However, how traumatic brain injury, dementia and epilepsy, which may directly cause head injury through a seizure or indeed be a consequence of a previous head injury, intersect remains incompletely determined.
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How To Find Help For Caregiving
As the person moves through the stages of Alzheimer’s, he or she will need more care. You may not be able to meet all his or her needs at home anymore. It’s important to know your limits, take care of yourself, and to seek help whenever you need it. Learn more about getting help with Alzheimer’s caregiving and finding ways to care for yourself. If caring for the person has become too much for you, you can also learn more about finding long-term care for a person with Alzheimer’s.
When The Person With Alzheimers Can’t Move
During the later stages of Alzheimers disease, a person may lose the ability to move and spend much of his or her time in a bed or chair. This lack of movement can cause problems such as pressure sores or bedsores, and stiffness of the arms, hands, and legs.
If the person with Alzheimers cannot move around on his or her own, contact a home health aide, physical therapist, or nurse for help. These professionals can show you how to move the person safely, such as changing positions in bed or in a chair.
A physical therapist can also show you how to move the person’s body joints using range-of-motion exercises. During these exercises, you hold the person’s arms or legs, one at a time, and move and bend it several times a day. Movement prevents stiffness of the arms, hands, and legs. It also prevents pressure sores or bedsores.
To make the person more comfortable:
To keep from hurting yourself when moving someone with Alzheimer’s disease:
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Network Hyperactivation In Patients With Alzheimers Disease
Also in humans, network hyperexcitability in temporal regions has been related to memory dysfunction and AD pathogenesis. In patients with MCI due to AD, task-based functional magnetic resonance imaging studies have shown increased hippocampal activation during memory encoding , probably linked to compensatory recruitment of neural reserves. Nevertheless, the findings of the study indicate that compensatory hyperactivation of the hippocampus and multiple other cortical and subcortical brain regions during encoding is ineffective, might contribute to AD pathogenesis and predict future cognitive decline . Interestingly, treatment with Levetiracetam in patients with amnestic MCI, suppressing hippocampal dentate gyrus and CA3 hyperactivation, normalized fMRI changes and improved their performance on a hippocampal-based pattern-separation task . Additionally, functional studies with PET evidenced that network hyperactivation may spread to regions outside the hippocampus in early stages of AD, including the default mode network , indicated by failure to deactivate this network during memory encoding. Finally, resting-state MEG has shown network hypersynchronization across multiple frequency bands in frontoparietal and interhemispheric networks in patients with amnestic MCI .
Changes In Mood Emotions And Perceptions
Changes in mood remain in the later stages of dementia. Depression and apathy are particularly common.
Delusions and hallucinations are most common in the late stage of dementia. They are not always distressing but they can explain some changes in behaviour because the persons perception of reality is altered.
People with later stage dementia often respond more to senses than words. They may like listening to songs or enjoy textures. For example, they may like the feel of different types of material.
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Late Stages Of Alzheimers Disease Symptoms
The needs of the person with Alzheimers become much more demanding as the disease progresses. In the late stages of Alzheimers, the person with the disease loses the ability to respond appropriately and is unable to converse with others. They will also develop an inability to control movements like sitting, standing and walking.
Here are some other common symptoms of the disease that can occur:
- Catches colds and infections easily
- Day/night reversal of sleep pattern
- Difficulty communicating
- Difficulty using the toilet independently
- Eventually requires help with activities of daily living, 24 hours per day
- Eventually unable to walk
- Hoarding, rummaging
- Inability to sit and eventually to swallow
- Loss of awareness of surroundings
- Needs help walking
- Needs progressively more help with personal care
- Personality changes such as aggression, anxiety, hostility, irritability or uncooperativeness
- Repetitive questioning
- Verbally aggressive or demanding behavior
What Is The Life Expectancy For Later Stage Dementia
A person with later stage dementia often deteriorates slowly over many months. They gradually become more frail, and will need more help with everyday activities such as eating, dressing, washing and using the toilet. People may experience weight loss, as swallowing and chewing become more difficult.
A person with later stage dementia may also have symptoms that suggest they are close to death, but continue to live with these symptoms for many months. This can make it difficult for the person and their family to plan for the end of life. It also makes it difficult for those supporting them professionally.
For more information on supporting someone with later stage dementia, see Alzheimers Society factsheet, The later stages of dementia .
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The Later Stage Of Dementia The Later Stage Of Dementia
People with later-stage dementia will eventually need full-time care and support with daily living and personal care, such as eating, washing and dressing. Whatever kind of dementia a person has, their life expectancy is on average lower.
The progression and stages of dementiaThe progression and stages of dementia .
Dementia is a life-limiting condition and there is information about later-stage dementia and life expectancy on this page. Some people may find this upsetting and difficult to think about.
For more general information about the different stages of dementia, see The progression and stages of dementia page.
By the later stage of dementia, the condition will have a severe impact on most aspects of a persons life. The person will eventually need full-time care and support with daily living and personal care, such as eating, washing and dressing. This support can be provided by care at home but is more often given in a care home setting.
Symptoms of all kinds are likely to cause the person considerable difficulties in this stage, but altered perception and physical problems are often the most noticeable. By the late stage, the symptoms of all types of dementia become very similar.
The later stage of dementia tends to be the shortest. On average it lasts about one to two years.
Are you supporting a person with later-stage dementia?Are you supporting a person with later-stage dementia? .
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We had to design a very conservative study that takes these participants out, said Ophir Keret, a neurologist at the University of California, San Francisco who was a researcher on both studies, because we wanted to isolate the effect that epilepsy would have.
Michela Gallagher, a professor of psychology and neuroscience at Johns Hopkins University, said the researchers used good criteria for defining unprovoked seizures independent of things that could be causing , and pointed to the large sample size and long time period for tracking each veterans health trajectory as two of the studys strengths. One weakness she noted is that the Veterans Affairs health data used in the study did not allow researchers to differentiate between Alzheimers or other types of dementia. Neither the veterans study or the smaller one has been published yet in a peer-reviewed journal.
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Diagnosing Seizures In The Elderly
Making a diagnosis of a seizure disorder in elderly patients with dementia can be challenging due to factors previously mentioned. Localization-related epilepsy with origin in the temporal lobes with semiology of altered awareness is the most common seizure type in this setting.5,6 African American ethnicity, lower Mini-Mental Status Examination score at initial evaluation, longer symptom duration, lower level of education attained, and focal epileptiform findings on EEG are all predictors of unprovoked seizures in persons with AD.3 Other etiologies that cause patients to present with transient loss of awareness should be considered when evaluating these patients.
As an additional consideration in this population, seizures can be mistaken for progression of dementia. Confusion and altered awareness during or following an unrecognized complex partial seizure may be attributed to symptoms of dementia or delirium.1