Różnice między płciami w związku między dawką leków przeciwpadaczkowych a zaburzeniami pamięci u starszych osób z epilepsją: badanie prospektywne
Sex difference in the association of antiseizure medication load with cognitive decline in older people with epilepsy: A prospective study
W skrócie
Badanie pokazało, że większa ilość leków przeciwpadaczkowych wiąże się u starszych kobiet z epilepsją szybszym pogorszeniem pamięci, podczas gdy u mężczyzn tego nie zaobserwowano. Efekt był szczególnie silny u kobiet, u których epilepsja pojawiła się wcześnie, trwała dłużej lub była dobrze kontrolowana lekami. Wyniki sugerują, że przy wyborze leczenia dla starszych kobiet z epilepsją należy zwracać większą uwagę na potencjalne wpływy leków na funkcje pamięci i poznawcze.
Oryginalny abstract (angielski)
OBJECTIVE: This study aimed to investigate the association between total antiseizure medication (ASM) load and longitudinal cognitive decline in older people with epilepsy, with a focus on sex difference and potential moderating clinical factors. METHODS: In this prospective cohort study, 205 people with epilepsy aged ≥ 50 years were recruited and followed annually. During a mean follow-up of 3.7 years, 72 participants were lost to follow-up, leaving 133 participants for the longitudinal analyses. Total ASM load was quantified using the total defined daily dose (TDDD). Cognitive function was assessed using a comprehensive neuropsychological battery covering global cognition, memory, attention, executive function, language, and visuospatial ability. Annual rates of cognitive decline were calculated. Multivariate linear regression and interaction models were applied to examine the associations between TDDD and cognitive decline, stratified by sex and moderated by age at onset, disease duration, seizure frequency, and etiology. RESULTS: Higher ASM load was associated with faster memory decline in women (β = -0.68, 95 % CI: [-1.15, -0.22], p = 0.005), but not in men. Among women, earlier age at onset, longer disease duration, and seizure freedom significantly amplified the negative association between TDDD and cognitive outcomes, particularly global cognition, attention, and executive function. In contrast, no significant associations were observed in men. Etiology unknown did not significantly modify these associations in either sex. CONCLUSION: The impact of cumulative ASM load with memory domain in older people with epilepsy shows sex differences. Older women, especially those with earlier onset, longer disease duration, and well-controlled seizures, may exhibit higher vulnerability to medication-related cognitive decline. Our findings suggest that cognitive function may warrant further consideration in the clinical management of older women with epilepsy receiving ASM.