Utility of Amyloid Positron Emission Tomography Imaging in Older Adults With Epilepsy and Cognitive Decline

In older adults with cognitive decline and epilepsy, diagnosing the etiology of cognitive decline is challenging. We identified 6 subjects enrolled in the Imaging Dementia-Evidence of Amyloid Imaging Scanning (IDEAS) study and nonlesional epilepsy. Three cognitive neurologists reviewed each case to determine the likelihood of underlying Alzheimer's disease (AD) pathology. Their impressions were compared to amyloid PET findings. In 3 cases the impression was concordant with PET findings. In 2 cases "possibly suggestive," the PET reduced diagnostic uncertainty, with 1 having a PET without elevated amyloid and the other PET with intermediate amyloid. In the remaining case with lack of reviewer concordance, the significance of PET with elevated amyloid remains uncertain. This case series highlights that in individuals with a history of epilepsy and cognitive decline, amyloid PET can be a useful tool in evaluating the etiology of cognitive decline when used in an appropriate context.

A-163 Utility of the 7/24 Spatial Recall Test in Temporal Lobe Epilepsy

Objective

To examine the utility of the 7/24 Spatial Recall Test (7/24) in the assessment of temporal lobe epilepsy (TLE) patients who have not undergone surgical resection. We hypothesized that patients with right TLE (RTLE) would perform significantly worse on the 7/24 than patients with left TLE (LTLE), but better on measures of verbal memory and naming.

Participants and Methods

Twenty-one patients with RTLE and 17 patients with LTLE were identified from a larger dataset of 152 epilepsy patients who underwent comprehensive neuropsychological evaluations at Brigham and Women’s Hospital. Exclusion criteria included: 1) Extratemporal, bitemporal, or unclear seizure onset, 2) Post-surgical evaluations, and 3) Co-morbid neurodegenerative or neurological conditions. The Rey Auditory Verbal Learning Test (RVLT) and Boston Naming Test (BNT) and were selected as outcome measures of verbal memory and naming, respectively.

Results

Independent samples t-tests revealed that patients with RTLE performed significantly worse on the 7/24 delayed recall than LTLE patients (p = 0.026), but there were no significant differences between groups in their 7/24 immediate recall across trials (p = 0.118). As predicted, patients with LTLE performed significantly worse than RTLE patients on the BNT (p = 0.005), however no significant differences were found between groups on the RVLT total learning, short delay, or long delay.

Conclusions

These findings support the use of the 7/24 for assessing nonverbal memory in patients with TLE, and more specifically, suggest that the 7/24 may be a sensitive measure for detecting lateralized dysfunction of the right temporal lobe in TLE patients.

Mindfulness and Cognitive Training Interventions in Mild Cognitive Impairment: Impact on Cognition and Mood

With the lack of disease-modifying pharmacologic treatments for mild cognitive impairment and dementia, there has been an increasing clinical and research focus on nonpharmacological interventions for these disorders. Many treatment approaches, such as mindfulness and cognitive training, aim to mitigate or delay cognitive decline, particularly in early disease stages, while also offering potential benefits for mood and quality of life. In this review, we highlight the potential of mindfulness and cognitive training to improve cognition and mood in mild cognitive impairment. Emerging research suggests that these approaches are feasible and safe in this population, with preliminary evidence of positive effects on aspects of cognition (attention, psychomotor function, memory, executive function), depression, and anxiety, though some findings have been unclear or limited by methodological weaknesses. Even so, mindfulness and cognitive training warrant inclusion as current treatments for adults with mild cognitive impairment, even if there is need for additional research to clarify treatment outcomes and questions related to dose, mechanisms, and transfer and longevity of treatment effects.

Cognitive impairment and evaluation in psychogenic nonepileptic seizures: an integrated cognitive-emotional approach

Neuropsychological studies comparing patients with psychogenic nonepileptic seizures (PNES) to those with epilepsy have been largely equivocal. The variability in the neuropsychological literature highlights the heterogeneity of the PNES population across a number of psychiatric and neurologic factors. Phenotypic presentations in PNES arise from complex interactions between vulnerable cognitive and emotional systems. We propose that variability in neuropsychological findings in PNES emerge in the context of diverse psychiatric, neurologic, and clinical factors. Traditional assessments that fail to integrate cognitive and emotional/behavioral profiles sufficiently would fall short in characterizing the complexity of brain-behavior relationships in this population. To advance the neuropsychology of PNES, we propose a systematic approach to measure a number of factors that influence cognitive impairment in this population. We begin by reviewing the current neuropsychological literature in PNES and discussing a number of factors that influence cognitive deficits. We then present a comprehensive neuropsychological battery designed to capture elements (cognitive dysfunction, psychopathology, emotion processing deficits) underlying the proposed vulnerable cognitive-emotional system in PNES. It is our hope that the proposed battery will facilitate the aggregation of data across neuropsychological investigations, to allow more advanced statistical analyses, and ultimately enhance our understanding of PNES and the development of effective management and treatment options.