August 15, 2025Open Access

Before It's Too Late: Recognizing the Impact of Seizures and Risk Factors for Late-Onset Epilepsy in Dementia and Mild Cognitive Impairment

Key Points

Recurrent seizures significantly increase mortality risk compared to no seizures in individuals with dementia, highlighting critical health issues.
In a cohort of over 26,500 patients, recurrent seizures were tied to a median survival time of only 2.4 years, compared to 4.7 years for no seizures.
This longitudinal analysis across 39 Alzheimer's disease centers examined the impact of seizure status on cognition and daily functioning.
Findings underscore the importance of timely seizure management to improve health outcomes and quality of life for patients with dementia.

Abstract

Association of Seizure Control with Mortality, Cognition, and Function in People With Dementia Zawar I, Quigg M, Ghosal S, Punia V, Calle-Lopez Y, Manning C, Kapur J. Ann Neurol . 2025;97(2):358–368. doi: 10.1002/ana.27125. Epub 2024 Oct 30. PMID: 39475168 Objectives: The effects of seizure control on outcomes in persons with dementia (PWD) remain unclear. Our study aimed to investigate the impact of seizure control on mortality, function, cognition, and mood among PWD. Methods: This longitudinal, multicenter study is based on 39 Alzheimer's disease centers (ADCs) in the United States from September 2005 to December 2021. PWD were grouped by seizure status into recurrent (seizures in the past year), remote (prior seizures but none in the past year), and no seizures (controls). The primary outcome was all-cause mortality among seizure groups. We used Weibull survival analysis to assess the mortality risks by seizure status after adjusting for age, sex, education, race, ethnicity, hypertension, diabetes, hyperlipidemia, degree of cognitive impairment, dominant Alzheimer's disease (AD) mutation, brain trauma, stroke, Parkinson's disease, alcohol abuse, and depression. Cognition (Clinical Dementia Rating), function (physical dependence and nursing home residence), day-to-day activities (Functional Assessment Scores), and mood (Geriatric Depression Scale) were compared among seizure groups after adjusting for dementia duration and age. Results: Among 26,501 participants, 374 (1.4%) had recurrent seizures and 510 (1.9%) had remote seizures. In multivariable survival analysis, recurrent seizures were associated with a higher mortality risk than remote and no seizures (adjusted hazard ratio aHR, 95% conﬁdence interval 95% CI; recurrent aHR = 1.79, 95% CI = 1.51 to 2.12; remote aHR = 1.17, 95%CI = 0.98 to 1.38). Median time-to-death for recurrent, remote, and no seizures was 2.4, 4.0, and 4.7 years, respectively. People with recurrent seizures had worse cognition, day-to-day function, and physical dependence than those with remote seizures and controls. Interpretation: PWD with poorly controlled recurrent seizures have worse mortality, functional, and cognitive outcomes than PWD with remote and no seizures. These ﬁndings underscore the need for timely identiﬁcation and management of ongoing seizures in PWD.

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