Risk for Late-Onset Epilepsy Linked to a Class of Protein, Smoking, Diabetes

Risk for Late-Onset Epilepsy Linked to a Class of Protein, Smoking, Diabetes

A recent study has shown that a class of proteins involved in the metabolism of fats in the body. Apolipoprotein E ε4 (APOE ε4) genotype and the presence of potentially modifiable risk factors such as smoking, hypertension, and diabetes in midlife are associated with a higher risk for late-onset epilepsy.

Participants from the Atherosclerosis Risk in Communities (ARIC) study were enrolled in it. At baseline, the investigators collected data on demographics, lifestyle factors, vascular status, and potential epilepsy risk factors. At first study visit, the median participant age was 55 years. The main outcome was the time to late-onset epilepsy development at age less than 60 years of age. Participants were followed from 1987-1989 through 2013.

During follow-up, a total of 596 patients developed late-onset epilepsy, representing a rate of 3.33 per 1000 person-years. Black patients had a higher incidence rate of late-onset epilepsy compared with white participants (4.71 per 1000 vs. 2.88 per 1000 respectively).

Patients who had hypertension at baseline were more likely to develop late-onset epilepsy during follow-up according to findings of the multivariable analysis. Additional baseline variables associated with a higher risk of late-onset epilepsy included diabetes, smoking, APOE ε4 genotype, incident stroke, and dementia. The risk for late-onset epilepsy was lower in patients with higher physical activity levels and moderate alcohol intake.

A limitation of the study included the use of claims codes for identifying epilepsy cases, which may have introduced misclassification of some patients.

Overall, the findings from the study suggest “a possible role of vascular disease and neurodegeneration in the development of late-onset epilepsy.”

Source: Neurology Advisor and JAMA Neurology

Note:  The apolipoprotein E ε4 (APOE ε4) is important in Alzheimer’s disease and cardiovascular disease. Lipoproteins are molecules composed of fats and proteins.

 

Epilepsy and Seizures in Older Adults

Epilepsy and Seizures in Older Adults

Did you know that epilepsy is more likely to develop in older adults? Seizures can be easy to miss. Learn how to recognize the signs and how you can help.

 
Epilepsy is brain disorder that causes repeated seizures. About 3 million US adults aged 18 years or older have active epilepsy.1 Nearly 1 million of those adults are aged 55 or older.1 As our population ages, there will be even more older people with epilepsy in the coming years.
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Epilepsy Treatment Often Delayed in Older Adults

Epilepsy Treatment Often Delayed in Older Adults

A new study published in Epilepsia found that although most newly diagnosed cases of epilepsy in older adults are treated appropriately with monotherapy, only half of those patients receive treatment within the recommended time frame, and a substantial portion were prescribed older antiepileptic drugs (AEDs) despite recommendations to use newer AEDs in this population. (more…)

AAN: People who develop diabetes in middle age are more likely to have brain cell loss in old age

AAN: People who develop diabetes in middle age are more likely to have brain cell loss in old age

article-0-1C1A82F200000578-639_634x520People who develop diabetes and high blood pressure in middle age are more likely to have brain cell loss and other damage to the brain, as well as problems with memory and thinking skills, than people who never have diabetes or high blood pressure or who develop it in old age, according to a new study published in the March 19, 2014, online issue of Neurology®, the medical journal of the American Academy of Neurology. Middle age was defined as age 40 to 64 and old age as age 65 and older.

“Potentially, if we can prevent or control diabetes and high blood pressure in middle age, we can prevent or delay the brain damage that occurs decades later and leads to memory and thinking problems and dementia,” said study author Rosebud O. Roberts, MB, ChB, MS, of the Mayo Clinic in Rochester, Minn., and a member of the American Academy of Neurology.

For the study, the thinking and memory skills of 1,437 people with an average age of 80 were evaluated. The participants had either no thinking or memory problems or mild memory and thinking problems called mild cognitive impairment. They then had brain scans to look for markers of brain damage that can be a precursor to dementia. Participants’ medical records were reviewed to determine whether they had been diagnosed with diabetes or high blood pressure in middle age or later.

For diabetes, 72 people developed it in middle age, 142 in old age and 1,192 did not have diabetes. For high blood pressure, 449 people developed it in middle age, 448 in old age and 369 did not have it.

Compared to people who did not have diabetes, people who developed diabetes in middle age had total brain volume an average of 2.9 percent smaller. In thehippocampus area of the brain, the volume was 4 percent smaller. They were also twice as likely to have thinking and memory problems.

Compared to people who did not have high blood pressure, people who developed high blood pressure in middle age were twice as likely to have areas of brain damage.

“People who developed diabetes even in old age were also more likely to have areas of brain damage. Conversely, there were not many effects from high blood pressure that developed in old age,” Roberts said. “Overall, our findings suggest that the effects of these diseases on the brain take decades to develop and show up as brain damage and lead to symptoms that affect their memory and other thinking skills. In particular, diabetes has adverse effects regardless of the age at which diabetes develops.”

Source: American Academy of Neurology

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