Cognitive impairment in adults with epilepsy: The relationship between subjective and objective assessments of cognition

Article English OPEN
Samarasekera, S.R. ; Helmstaedter, C. ; Reuber, M. (2015)
  • Publisher: Elsevier

Aim: This study aimed to assess the relationship between objective measures of cognition and subjective perception of cognitive functioning reported by patients with epilepsy and their caregivers. \ud \ud Methods: One hundred patients with epilepsy attending hospital neurology outpatient clinics and their caregivers were enrolled in this study. The EpiTrack® (version 1) brief cognitive screening tool was used to measure objective impairment, the ABNAS questionnaire (A-B Neuropsychological Assessment Schedule) to assess subjective cognitive performance, and a version of the ABNAS designed to be completed by caregivers (C-ABNAS) to document caregivers' views. Patient anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS) and considered as covariates. Patients with an uncertain diagnosis of epilepsy or likely severe comorbid mood or anxiety disorders were excluded. \ud \ud Results: Data from 82 patients were analyzed after exclusion of patients with uncertain diagnoses or likely severe comorbid mood or anxiety disorders. Fifty-nine (72%) had a degree of objective cognitive impairment. Fifty (84.7%) of these 59 patients had 'high' ABNAS scores concordant with the objective assessment, and 43 (72.9%) had high C-ABNAS scores matching the abnormalities detected by objective screening. Of the 23 (28%) patients without objective cognitive impairment, seven (30.4%) had concordantly low ABNAS scores, and 10 (43.4%) had concordantly low C-ABNAS scores. Patient memory impairment was more often reported by patients themselves than by caregivers (p. =. 0.011). Carers were significantly more likely to rate patients as having impaired motor coordination than patients themselves.A small part of the variance of the EpiTrack score was predicted by the C-ABNAS.Objective cognitive performance did not predict ABNAS or C-ABNAS scores. \ud \ud Conclusions: Self-report or caregiver report questionnaires identify patients with epilepsy and objective cognitive impairment more accurately than patients with intact cognition. Those without objective evidence of cognitive impairment may, nevertheless, perceive themselves as having memory dysfunction; it is these patients, therefore, who most require both subjective and objective assessments of cognition, including carers' assessments, in order to establish the nature of their symptoms. None of these assessment measures can be used as a reliable proxy for another, each contributes individually to a comprehensive assessment of cognition, and all must be used in conjunction with measures of mood and anxiety.
  • References (23)
    23 references, page 1 of 3

    Aldenkamp, A. P., G. Baker, et al. (1995). "The Neurotoxicity Scale: The validity of a patientbased scale, assessing neurotoxicity." Epilepsy Research 20(3): 229-239.

    Aldenkamp, A. P. and G. A. Baker (1997). "The Neurotoxicity Scale-II: Results of a patientbased scale assessing neurotoxicity in patients with epilepsy." Epilepsy Research 27(3): 165- 173.

    Aldenkamp, A. P., H. F. van Meel, et al. (2002). "The A-B neuropsychological assessment schedule (ABNAS): the relationship between patient-perceived drug related cognitive impairment and results of neuropsychological tests." Seizure 11(4): 231-237.

    Andrewes, D., K. Camp, et al. (1999). "The assessment and treatment of concerns and anxiety in patients undergoing presurgical monitoring for epilepsy." Epilepsia 40(11): 1535- 1542.

    Brooks, J., G. A. Baker, et al. (2001). "The A-B neuropsychological assessment schedule (ABNAS): the further refinement of a patient-based scale of patient-perceived cognitive functioning." Epilepsy Res 43(3): 227-237.

    Elixhauser, A., N. K. Leidy, et al. (1999). "The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy." Epilepsy Res 37(1): 13-24.

    Hall, K. E., C. L. Isaac, et al. (2009). "Memory complaints in epilepsy: an accurate reflection of memory impairment or an indicator of poor adjustment? A review of the literature." Clin Psychol Rev 29(4): 354-367.

    Helmstaedter, C. (2005). EpiTrack® A Change-sensitive Cognitive Screening Tool for Qualityand Outcome Control in the Pharmacological Treatment of Epilepsy Bonn, Germany, University Clinic for Epileptology Helmstaedter, C. and C. E. Elger (2000). "Behavioral markers for self- and other-attribution of memory: a study in patients with temporal lobe epilepsy and healthy volunteers." Epilepsy Research 41: 235-243.

    Helmstaedter, C. and J. A. Witt (2008). "The effects of levetiracetam on cognition: a noninterventional surveillance study." Epilepsy Behav 13(4): 642-649.

    Helmstaedter, C. and J. A. Witt (2010). "Cognitive outcome of antiepileptic treatment with levetiracetam versus carbamazepine monotherapy: a non-interventional surveillance trial." Epilepsy Behav 18(1-2): 74-80.

  • Metrics
    0
    views in OpenAIRE
    0
    views in local repository
    141
    downloads in local repository

    The information is available from the following content providers:

    From Number Of Views Number Of Downloads
    White Rose Research Online - IRUS-UK 0 141
Share - Bookmark