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Reyes A, Hermann BP, Prabhakaran D, Ferguson L, Almane DN, Shih JJ, Iragui-Madoz VJ, Struck A, Punia V, Jones JE, Busch RM, McDonald CR. Validity of the MoCA as a cognitive screening tool in epilepsy: Are there implications for global care and research? Epilepsia Open 2024. [PMID: 38874380 DOI: 10.1002/epi4.12991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) as the gold standard. METHODS Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC-CoDE taxonomy divided participants into IC-CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests. RESULTS IC-CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336-2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency. SIGNIFICANCE This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed. PLAIN LANGUAGE SUMMARY The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, California, USA
| | - Bruce P Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Divya Prabhakaran
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, California, USA
| | - Lisa Ferguson
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dace N Almane
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jerry J Shih
- Department of Neuroscience, University of California, San Diego, California, USA
| | | | - Aaron Struck
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vineet Punia
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jana E Jones
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Robyn M Busch
- Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carrie R McDonald
- Department of Radiation Medicine & Applied Sciences, University of California, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
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Bu J, Ren N, Wang Y, Wei R, Zhang R, Zhu H. Identification of abnormal closed-loop pathways in patients with MRI-negative pharmacoresistant epilepsy. Brain Imaging Behav 2024:10.1007/s11682-024-00880-z. [PMID: 38592332 DOI: 10.1007/s11682-024-00880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
Epilepsy is a disorder of brain networks, that is usually combined with cognitive and emotional impairment. However, most of the current research on closed-loop pathways in epilepsy is limited to the neuronal level or has focused only on known closed-loop pathways, and studies on abnormalities in closed-loop pathways in epilepsy at the whole-brain network level are lacking. A total of 26 patients with magnetic resonance imaging-negative pharmacoresistant epilepsy (MRIneg-PRE) and 26 healthy controls (HCs) were included in this study. Causal brain networks and temporal-lag brain networks were constructed from resting-state functional MRI data, and the Johnson algorithm was used to identify stable closed-loop pathways. Abnormal closed-loop pathways in the MRIneg-PRE cohort compared with the HC group were identified, and the associations of these pathways with indicators of cognitive and emotional impairments were examined via Pearson correlation analysis. The results revealed that the abnormal stable closed-loop pathways were distributed across the frontal, parietal, and occipital lobes and included altered functional connectivity values both within and between cerebral hemispheres. Four abnormal closed-loop pathways in the occipital lobe were associated with emotional and cognitive impairments. These abnormal pathways may serve as biomarkers for the diagnosis and guidance of individualized treatments for MRIneg-PRE patients.
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Affiliation(s)
- Jinxin Bu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Nanxiao Ren
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Yonglu Wang
- Child Mental Health Research Center, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Ran Wei
- Division of Child Care, Suzhou Municipal Hospital, No. 26 Daoqian Road, Suzhou, Jiangsu, 215002, China
| | - Rui Zhang
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Haitao Zhu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
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Easwaran K, Ramakrishnan K, Jeyabal SN. Classification of cognitive impairment using electroencephalography for clinical inspection. Proc Inst Mech Eng H 2024; 238:358-371. [PMID: 38366360 DOI: 10.1177/09544119241228912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Impairment in cognitive skill though set-in due to various diseases, its progress is based on neuronal degeneration. In general, cognitive impairment (CI) is divided into three stages: mild, moderate and severe. Quantification of CI is important for deciding/changing therapy. Attempted in this work is to quantify electroencephalograph (EEG) signal and group it into four classes (controls and three stages of CI). After acquiring resting state EEG signal from the participants, non-local and local synchrony measures are derived from phase amplitude coupling and phase locking value. This totals to 160 features per individual for each task. Two types of classification networks are constructed. The first one is an artificial neural network (ANN) that takes derived features and gives a maximum accuracy of 85.11%. The second network is convolutional neural network (CNN) for which topographical images constructed from EEG features becomes the input dataset. The network is trained with 60% of data and then tested with remaining 40% of data. This process is performed in 5-fold technique, which yields an average accuracy of 94.75% with only 30 numbers of inputs for every individual. The result of the study shows that CNN outperforms ANN with a relatively lesser number of inputs. From this it can be concluded that this method proposes a simple task for acquiring EEG (which can be done by CI subjects) and quantifies CI stages with no overlapping between control and test group, thus making it possible for identifying early symptoms of CI.
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Affiliation(s)
- Karuppathal Easwaran
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
| | - Kalpana Ramakrishnan
- Department of Biomedical Engineering, Rajalakshmi Engineering College, Chennai, Tamil Nadu, India
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Kerr WT, McFarlane KN. Machine Learning and Artificial Intelligence Applications to Epilepsy: a Review for the Practicing Epileptologist. Curr Neurol Neurosci Rep 2023; 23:869-879. [PMID: 38060133 DOI: 10.1007/s11910-023-01318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Machine Learning (ML) and Artificial Intelligence (AI) are data-driven techniques to translate raw data into applicable and interpretable insights that can assist in clinical decision making. Some of these tools have extremely promising initial results, earning both great excitement and creating hype. This non-technical article reviews recent developments in ML/AI in epilepsy to assist the current practicing epileptologist in understanding both the benefits and limitations of integrating ML/AI tools into their clinical practice. RECENT FINDINGS ML/AI tools have been developed to assist clinicians in almost every clinical decision including (1) predicting future epilepsy in people at risk, (2) detecting and monitoring for seizures, (3) differentiating epilepsy from mimics, (4) using data to improve neuroanatomic localization and lateralization, and (5) tracking and predicting response to medical and surgical treatments. We also discuss practical, ethical, and equity considerations in the development and application of ML/AI tools including chatbots based on Large Language Models (e.g., ChatGPT). ML/AI tools will change how clinical medicine is practiced, but, with rare exceptions, the transferability to other centers, effectiveness, and safety of these approaches have not yet been established rigorously. In the future, ML/AI will not replace epileptologists, but epileptologists with ML/AI will replace epileptologists without ML/AI.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA.
- Department of Biomedical Informatics, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA.
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Katherine N McFarlane
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA
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Hoxhaj P, Habiya SK, Sayabugari R, Balaji R, Xavier R, Ahmad A, Khanam M, Kachhadia MP, Patel T, Abdin ZU, Haider A, Nazir Z. Investigating the Impact of Epilepsy on Cognitive Function: A Narrative Review. Cureus 2023; 15:e41223. [PMID: 37525802 PMCID: PMC10387362 DOI: 10.7759/cureus.41223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/02/2023] Open
Abstract
It has been noted that people who have epilepsy have an increased propensity for cognitive dysfunction. We explored 25 relevant articles on PubMed and Cochrane Library after implementing inclusion criteria. Different factors have been postulated and studied that may cause cognitive dysfunction in these patients; structural brain abnormalities, polypharmacy of antiepileptic medication, and neuropsychiatric disorders are the most common causes. Cognitive assessments such as Montreal Cognitive Assessment (MOCA) and Mini-Mental State Exam (MMSE) are the mainstay tools used to diagnose the degree of cognitive decline, and alterations in EEG (electroencephalogram) parameters have also been noted in people with cognitive decline. The mechanisms and treatments for cognitive decline are still being studied, while attention has also been directed toward preventive and predictive methods. Early detection and treatment of cognitive impairment can help minimize its impact on the patient's quality of life. Regular cognitive assessments are essential for epileptic patients, particularly those on multiple antiepileptic drugs. While proper management of epilepsy and related comorbidities would reduce cognitive decline and improve the overall quality of life for people with epilepsy.
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Affiliation(s)
- Pranvera Hoxhaj
- Medicine, University of Medicine, Tirana, Tirana, ALB
- Obstetrics and Gynaecology, Scher & Kerenyi MDS, New York, USA
| | - Sana K Habiya
- Internal Medicine, Indian Institute of Medical Science and Research, Jalna, IND
- Public Health, Northeastern Illinois University, Chicago, USA
| | | | - Roghan Balaji
- Neurology, Ponjesly Super Speciality Hospital, Nagercoil, IND
- Neurology, Sri Manakula Vinayagar Medical College and Hospital, Pondicherry, IND
| | - Roshni Xavier
- Internal Medicine, Rajagiri Hospital, Aluva, IND
- Internal Medicine, Carewell Hospital, Malappuram, IND
| | - Arghal Ahmad
- Internal Medicine, Ziauddin University, Karachi, PAK
| | | | | | - Tirath Patel
- Internal Medicine, American University of Antigua, St John, ATG
| | - Zain U Abdin
- Internal Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | - Ali Haider
- Internal Medicine, Quetta Institute of Medical Sciences, Quetta, PAK
| | - Zahra Nazir
- Internal Medicine Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Wazema DH, Assefa ZM, Shiferaw BZ, Geleta OT, Haile TG. Magnitude of Cognitive Impairment Among Patients With Epilepsy at Health Institutions in Gurage Zone, Ethiopia. SAGE Open Nurs 2023; 9:23779608231154400. [PMID: 36818278 PMCID: PMC9936394 DOI: 10.1177/23779608231154400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Epilepsy is a widespread neurological disorder characterized by recurrent unprovoked seizures; it contributes to 1% of the global burden of diseases and can end in cognitive impairment. Objective To assess the magnitude and associated factors of cognitive impairment among patients with epilepsy. Method The study utilized an institution-based cross-sectional study design. All patients with epilepsy whose ages were above 18 years were the source population. The authors performed bivariate and multivariate logistic regression analyses. Finally, variables with a p-value <.05 were significantly associated. Result The magnitude of cognitive impairment is 25.6%. Having no family history of epilepsy (AOR=0.12; 95% CI [0.02, 0.61]), polytherapy (AOR=5.14; 95% CI [1.12, 23.62]), and medication-related complaints (AOR=8.24; 95% CI [1.87, 36.38]) were strongly associated with cognitive impairment. Conclusion Significant numbers of patients were positive for cognitive impairment. Family history, polytherapy, and medication-related complaints were associated factors.
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Affiliation(s)
- Deribachew Hailemariam Wazema
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia,Deribachew Hailemariam Wazema, Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Zebene Makonnen Assefa
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Bisrat Zeleke Shiferaw
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Omega Tolessa Geleta
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tariku Gebre Haile
- Department of Nursing, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Ren Z, Zhao Y, Han X, Yue M, Wang B, Zhao Z, Wen B, Hong Y, Wang Q, Hong Y, Zhao T, Wang N, Zhao P. An objective model for diagnosing comorbid cognitive impairment in patients with epilepsy based on the clinical-EEG functional connectivity features. Front Neurosci 2023; 16:1060814. [PMID: 36711136 PMCID: PMC9878185 DOI: 10.3389/fnins.2022.1060814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Objective Cognitive impairment (CI) is a common disorder in patients with epilepsy (PWEs). Objective assessment method for diagnosing CI in PWEs would be beneficial in reality. This study proposed to construct a diagnostic model for CI in PWEs using the clinical and the phase locking value (PLV) functional connectivity features of the electroencephalogram (EEG). Methods PWEs who met the inclusion and exclusion criteria were divided into a cognitively normal (CON) group (n = 55) and a CI group (n = 76). The 23 clinical features and 684 PLV EEG features at the time of patient visit were screened and ranked using the Fisher score. Adaptive Boosting (AdaBoost) and Gradient Boosting Decision Tree (GBDT) were used as algorithms to construct diagnostic models of CI in PWEs either with pure clinical features, pure PLV EEG features, or combined clinical and PLV EEG features. The performance of these models was assessed using a five-fold cross-validation method. Results GBDT-built model with combined clinical and PLV EEG features performed the best with accuracy, precision, recall, F1-score, and an area under the curve (AUC) of 90.11, 93.40, 89.50, 91.39, and 0.95%. The top 5 features found to influence the model performance based on the Fisher scores were the magnetic resonance imaging (MRI) findings of the head for abnormalities, educational attainment, PLV EEG in the beta (β)-band C3-F4, seizure frequency, and PLV EEG in theta (θ)-band Fp1-Fz. A total of 12 of the top 5% of features exhibited statistically different PLV EEG features, while eight of which were PLV EEG features in the θ band. Conclusion The model constructed from the combined clinical and PLV EEG features could effectively identify CI in PWEs and possess the potential as a useful objective evaluation method. The PLV EEG in the θ band could be a potential biomarker for the complementary diagnosis of CI comorbid with epilepsy.
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Affiliation(s)
- Zhe Ren
- Department of Neurology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China
| | - Yibo Zhao
- Department of Neurology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Xiong Han,
| | - Mengyan Yue
- Department of Rehabilitation, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Bin Wang
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zongya Zhao
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, Henan, China
| | - Bin Wen
- School of Life Sciences and Technology, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yang Hong
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, Henan, China
| | - Qi Wang
- Department of Neurology, Zhengzhou University People’s Hospital, Zhengzhou, Henan, China
| | - Yingxing Hong
- Department of Neurology, People’s Hospital of Henan University, Zhengzhou, Henan, China
| | - Ting Zhao
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Na Wang
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pan Zhao
- Department of Neurology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China
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