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Nakhla MZ, Bangen KJ, Schiehser DM, Roesch S, Zlatar ZZ. Greater subjective cognitive decline severity is associated with worse memory performance and lower entorhinal cerebral blood flow in healthy older adults. J Int Neuropsychol Soc 2024; 30:1-10. [PMID: 36781410 PMCID: PMC10423746 DOI: 10.1017/s1355617723000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Subjective cognitive decline (SCD) is a potential early risk marker for Alzheimer's disease (AD), but its utility may vary across individuals. We investigated the relationship of SCD severity with memory function and cerebral blood flow (CBF) in areas of the middle temporal lobe (MTL) in a cognitively normal and overall healthy sample of older adults. Exploratory analyses examined if the association of SCD severity with memory and MTL CBF was different in those with lower and higher cardiovascular disease (CVD) risk status. METHODS Fifty-two community-dwelling older adults underwent magnetic resonance imaging, neuropsychological testing, and were administered the Everyday Cognition Scale (ECog) to measure SCD. Regression models investigated whether ECog scores were associated with memory performance and MTL CBF, followed by similar exploratory regressions stratified by CVD risk status (i.e., lower vs higher stroke risk). RESULTS Higher ECog scores were associated with lower objective memory performance and lower entorhinal cortex CBF after adjusting for demographics and mood. In exploratory stratified analyses, these associations remained significant in the higher stroke risk group only. CONCLUSIONS Our preliminary findings suggest that SCD severity is associated with cognition and brain markers of preclinical AD in otherwise healthy older adults with overall low CVD burden and that this relationship may be stronger for individuals with higher stroke risk, although larger studies with more diverse samples are needed to confirm these findings. Our results shed light on individual characteristics that may increase the utility of SCD as an early risk marker of cognitive decline.
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Affiliation(s)
- Marina Z. Nakhla
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Ct, San Diego, CA
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Katherine J. Bangen
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Dawn M. Schiehser
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
- Research Service, VA San Diego Healthcare System, La Jolla, California, 3350 La Jolla Village Dr., San Diego, CA 92161
| | - Scott Roesch
- Department of Psychology, San Diego State University, 5500 Campanile Dr., San Diego, 92182
| | - Zvinka Z. Zlatar
- Department of Psychiatry; University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093
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Samudra N, Armour E, Gonzalez H, Mattingly D, Haas K, Singh P, Sonmezturk H, Gallagher M, Crudele A, Nobis W, Reddy S, Jacobs M, Aulino JM, Bick S, Morgan V, Englot D, Abou-Khalil B. Epilepsy with anterior temporal encephaloceles: Baseline characteristics, post-surgical outcomes, and comparison to mesial temporal sclerosis. Epilepsy Behav 2023; 139:109061. [PMID: 36587487 DOI: 10.1016/j.yebeh.2022.109061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/18/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review clinical and neuropsychological characteristics and natural history of a series of patients with temporal lobe epilepsy (TLE) and anterior temporal encephaloceles (ATE) and compare them to a similar series of TLE patients with mesial temporal sclerosis (MTS) to identify characteristics suggestive of ATE-related epilepsy. METHODS Patients with epilepsy and ATE were identified via clinic encounters and consensus epilepsy surgery conference at a Level 4 epilepsy center. The drug-resistant subset of these patients who underwent epilepsy surgery (twenty-two of thirty-five) were compared to age- and laterality-matched patients with MTS. Clinical, neuropsychological, electrophysiologic, and surgical data were abstracted through chart review. RESULTS In comparison with MTS, ATE patients were more often female, had significantly later onset of epilepsy, and did not have prior febrile seizures. In addition, ATE patients were more likely to have chronic headaches and other historical features consistent with idiopathic intracranial hypertension (IIH). Failure to identify ATE on initial imaging was common. Most patients had limited temporal cortical resections sparing mesial structures. Of the twenty ATE patients who had a long-term postsurgical follow-up, seventeen (85%) had International League Against Epilepsy (ILAE) Class 1 or 2 outcomes. SIGNIFICANCE A shorter duration of epilepsy, female gender, and lack of history of febrile seizures may suggest ATE as an etiology of refractory TLE in adults. Targeted encephalocele resections can result in seizure freedom, underscoring the importance of encephalocele identification.
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Affiliation(s)
- Niyatee Samudra
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Armour
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hernan Gonzalez
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Danielle Mattingly
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Haas
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pradumna Singh
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hasan Sonmezturk
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin Gallagher
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela Crudele
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Nobis
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shilpa Reddy
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Monica Jacobs
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph M Aulino
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Bick
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victoria Morgan
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dario Englot
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bassel Abou-Khalil
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Encephalocele-Associated Drug-Resistant Epilepsy of Adult Onset: Diagnosis, Management, and Outcomes. World Neurosurg 2021; 151:91-101. [PMID: 33964498 DOI: 10.1016/j.wneu.2021.04.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022]
Abstract
Epileptogenic encephaloceles, most frequently located in the temporal lobe, are a known lesional cause of focal epilepsy. Data are limited regarding diagnosis, management, and outcomes of patients with epilepsy in the setting of an encephalocele, because the literature mostly comprises case reports, case series, and retrospective studies. We conducted a broad literature review for articles related to encephaloceles and epilepsy regardless of level of evidence. Hence, this review provides a summary of all available literature related to the topic. Thirty-six scientific reports that fulfilled our inclusion criteria were reviewed. Most reported patients presented with focal impaired awareness seizures and/or generalized tonic-clonic seizures. Although most of the encephaloceles were located in the temporal lobe, we found 5 cases of extratemporal encephaloceles causing epilepsy. More patients who underwent either lesionectomy or lobectomy were seizure free at time of follow-up. In the temporal lobe, there is no clear consensus on the appropriate management for epileptic encephaloceles and further studies are warranted to understand the associated factors and long-term outcomes associated with epilepsy secondary to encephaloceles. Reported data suggest that these patients could be manageable with surgical procedures including lesionectomy or lobectomy. In addition, because of data suggesting similar results between procedures, a more conservative surgery with lesionectomy and defect repair rather than a lobectomy may have lower surgical risks and similar seizure freedom.
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