Abstracts

Rationale: Impairment in activities of daily living (ADLs) is often observed in patients with neurocognitive impairment. Studies of dementia patients show deficits in aspects of everyday functioning that correlate with cognitive dysfunction. Comparable studies in patients with epilepsy have not been conducted, although it could be inferred from dementia research that deficits in certain cognitively-based daily living skills would be expected in patients with circumscribed lesions. The purpose of this study was to examine the performance of patients with temporal lobe epilepsy (TLE) on cognitively-based daily living tasks. It was hypothesized that patients with TLE would demonstrate relatively more impairment on a test of everyday memory than on daily living tests tapping other cognitive domains and that everyday memory would correlate with neuropsychological memory test performance.Methods: Participants were fourteen patients (64% female) with TLE who underwent comprehensive neuropsychological testing as part of their pre-operative evaluation. The mean age was 37.8 ± 8.8 years, mean educational level was level 14.2 ± 1.9 years, and mean seizure duration was 22.8 ± 14.1 years. Subjects were administered the five Daily Living subtests of the Neuropsychological Assessment Battery (NAB). The NAB Daily Living subtests provide assessment of five functional domains [Attention, Executive Function, Language, Spatial, and Memory-Delayed Recall (Mem-DR)] that are highly congruent with analogous real-world behavior and serve as proxy measures for daily functioning.Results: Examination of T-scores demonstrated average performance of the TLE group on the Attention (42.4 ± 9.4), Executive Function (49.1 ± 8.9), Language (48.2 ± 10.1), and Spatial (47.7 ± 8.1) Daily Living subtests. In contrast, the TLE group mean Mem-DR T-score was more than one standard deviation below the mean of the normative sample (37.6 ± 13.5). Performance on Mem-DR did not correlate with age, education, seizure duration, or depression severity. There was a selective association with a neuropsychological test of delayed recall (Verbal Paired Associates; r=.71, p<.01). Mem-DR did not correlate significantly with other non-memory test scores or with Full Scale IQ.Conclusions: Evaluation of real-world, everyday functioning has not been systematically evaluated in patients with TLE, despite recognition that this is an important aspect of assessment for both chronic and surgical patients. While a strong association between TLE and memory test performance has been demonstrated, little is known about how location of the seizure focus affects everyday functioning. These preliminary findings indicate that patients with TLE show a selective impairment in everyday memory functioning relative to daily living tasks dependent other cognitive skills. Interventions to improve everyday memory performance may be warranted for patients showing memory deficits on neuropsychological testing. Future studies will examine post-surgical changes in cognitively-based ADLs in patients who eventually undergo resective surgery to treat their epilepsy.