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Abstract
Objective To assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS).
Methods We analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case–control designs and matched each case to 3 age-, sex- and FHS cohort–matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia.
Results A total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05–3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11–3.57, p = 0.021). In this group, among participants with any post–high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82–12.01], p = 0.001) compared to controls of the same educational attainment.
Conclusions There is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.
Glossary
- Aβ=
- β-amyloid;
- AD=
- Alzheimer dementia;
- AED=
- antiepileptic drug;
- CI=
- confidence interval;
- DLB=
- dementia with Lewy bodies;
- DSM-IV=
- Diagnostic and Statistical Manual of Mental Disorders, 4th edition;
- FHS=
- Framingham Heart Study;
- FTD=
- frontotemporal dementia;
- HR=
- hazard ratio;
- ICD-9=
- International Classification of Diseases–9;
- TBI=
- traumatic brain injury;
- VaD=
- vascular dementia
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors shared senior authorship.
Editorial, page 1074
- Received January 30, 2020.
- Accepted in final form August 3, 2020.
- © 2020 American Academy of Neurology
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