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Title: Psychiatric and cognitive characteristics of older adults admitted to a Video-EEG monitoring (VEM) unit.
Austin Authors: Hew, Anthony;Lloyd, Michael;Rayner, Genevieve ;Matson, Alice;Rychkova, Maria;Ali, Rashida;Winton-Brown, Toby;Perucca, Piero ;Kwan, Patrick;O'Brien, Terence J;Velakoulis, Dennis;Malpas, Charles B;Loi, Samantha M
Affiliation: Medicine (University of Melbourne)
Melbourne Neuropsychiatry Centre, University of Melbourne and NorthWestern Mental Health, Melbourne, VIC, Australia
Department of Psychiatry, University of Melbourne, Australia
Department of Neurosciences, Alfred Health, Australia
Melbourne School of Psychological Sciences, The University of Melbourne, Australia
Department of Psychiatry, Alfred Health, Prahran, Australia
Department of Medicine (RMH), The University of Melbourne, Australia
Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
Department of Neurosciences, Monash University, Australia
Department of Neurology, Alfred Health, Prahran, Australia
Department of Neuropsychiatry, The Royal Melbourne Hospital, Parkville, Australia
Issue Date: Jul-2021
Date: 2021-05-09
Publication information: Epilepsy & Behavior : E&B 2021; 120: 107987
Abstract: To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit. This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and 'other' diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales. Five-hundred and thirty three patients (71 older, 462 younger) aged 16-91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and 'other' in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group. Psychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.
DOI: 10.1016/j.yebeh.2021.107987
Journal: Epilepsy & Behavior : E&B
PubMed URL: 33979768
Type: Journal Article
Subjects: Cognition
Older adults with epilepsy
Psychiatric comorbidities
Psychogenic nonepileptic seizures (PNES)
Video-EEG monitoring (VEM)
Appears in Collections:Journal articles

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