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Stefanidou M, Beiser AS, Himali JJ, Peng TJ, Devinsky O, Seshadri S, Friedman D. Bi-directional association between epilepsy and dementia: The Framingham Heart Study. Neurology 2020; 95:e3241-e3247. [PMID: 33097599 DOI: 10.1212/wnl.0000000000011077] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the risk of incident epilepsy among participants with prevalent dementia and the risk of incident dementia among participants with prevalent epilepsy in the Framingham Heart Study (FHS). METHODS We analyzed prospectively collected data in the Original and Offspring FHS cohorts. To determine the risk of developing epilepsy among participants with dementia and the risk of developing dementia among participants with epilepsy, we used separate, nested, case-control designs and matched each case to 3 age-, sex- and FHS cohort-matched controls. We used Cox proportional hazards regression analysis, adjusting for sex and age. In secondary analysis, we investigated the role of education level and APOE ε4 allele status in modifying the association between epilepsy and dementia. RESULTS A total of 4,906 participants had information on epilepsy and dementia and dementia follow-up after age 65. Among 660 participants with dementia and 1,980 dementia-free controls, there were 58 incident epilepsy cases during follow-up. Analysis comparing epilepsy risk among dementia cases vs controls yielded a hazard ratio (HR) of 1.82 (95% confidence interval 1.05-3.16, p = 0.034). Among 43 participants with epilepsy and 129 epilepsy-free controls, there were 51 incident dementia cases. Analysis comparing dementia risk among epilepsy cases vs controls yielded a HR of 1.99 (1.11-3.57, p = 0.021). In this group, among participants with any post-high school education, prevalent epilepsy was associated with a nearly 5-fold risk for developing dementia (HR 4.67 [1.82-12.01], p = 0.001) compared to controls of the same educational attainment. CONCLUSIONS There is a bi-directional association between epilepsy and dementia. with either condition carrying a nearly 2-fold risk of developing the other when compared to controls.
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Affiliation(s)
- Maria Stefanidou
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio.
| | - Alexa S Beiser
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
| | - Jayandra Jung Himali
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
| | - Teng J Peng
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
| | - Orrin Devinsky
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
| | - Sudha Seshadri
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
| | - Daniel Friedman
- From the Framingham Heart Study (M.S., A.S.B., J.J.H., S.S.); Department of Neurology (M.S., A.S.B., J.J.H., S.S.), Boston University School of Medicine; Department of Biostatistics (A.S.B., J.J.H.), Boston University School of Public Health, MA; Department of Neurology (T.J.P.), Yale University School of Medicine, New Haven, CT; Department of Neurology (O.D., D.F.), NYU Grossman School of Medicine, New York, NY; and University of Texas Health Sciences Center (S.S.), San Antonio. Dr. Himali is currently affiliated with the Department of Population Health Sciences, University of Texas Health Science Center, San Antonio
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