Authors :
Presenting Author: Robyn Busch, PhD – Cleveland Clinic
Jarrod Dalton, PhD – Cleveland Clinic; Lara Jehi, MD – Cleveland Clinic; Lisa Ferguson, MA – Cleveland Clinic; Nikolas Krieger, MS – Cleveland Clinic; Aaron Struck, MD – University of Wisconsin Madison; Bruce Hermann, PhD – University of Wisconsin, Madison
Rationale:
Temporal lobe epilepsy (TLE) is the most common adult form of epilepsy and is associated with high risk for cognitive deficits and depressed mood. Demographic and clinical risk factors for poor neuropsychological outcomes have been identified; however, little is known about the role of environmental factors on cognition and mood in TLE. This study examined the relationship between neighborhood deprivation and neuropsychological function in adults with pharmacoresistant TLE.
Methods:
Eight hundred adults (median age 38; 58% female) with TLE completed a comprehensive neuropsychological evaluation as part of pre-surgical investigations. Test scores were used to derive composite domain scores for intelligence, attention, processing speed, language, executive function, visuospatial skills, verbal/visual memory, depression, and anxiety. Overall cognitive phenotype (i.e., intact, single-domain impairment, bi-domain impairment, generalized impairment) was also derived for each patient using the International Classification of Cognitive Disorders in Epilepsy. Patient addresses were extracted from electronic health records and used to calculate the University of Wisconsin Area Deprivation Index (ADI) for each individual. ADIs were categorized into groups according to quintiles (i.e., Quintile 1 = least disadvantaged, Quintile 5 = most disadvantaged). Kruskal-Wallis tests compared quintile groups on cognitive domain scores as well as mood and anxiety scores. Multivariable regression models, with and without ADI, were estimated for overall cognitive phenotype as well as for mood and anxiety scores. Results:
Effects of disadvantage (increasing ADI) were observed across all measured cognitive domains and with significant increases in symptoms of depression and anxiety. Further, patients in higher (more disadvantaged) ADI quintiles had increased odds of a worse cognitive phenotype. Patients who self-identified as members minoritized groups were over-represented in the highest ADI quintiles and were three times more likely to be in a more severe cognitive phenotype than non-Hispanic whites. However, ADI attenuated this relationship, suggesting a mediating effect of neighborhood deprivation on the relationship between race/ethnicity and cognitive phenotype. Conclusions:
Our results demonstrate that neighborhood deprivation accounts for a substantial proportion of the variance in cognitive and mood outcomes among individuals with pharmacoresistant TLE. These findings are consistent with prior research in other populations and highlight the importance of considering environmental factors and regional characteristics in neuropsychological studies of epilepsy. There are many potential mechanisms by which neighborhood disadvantage can adversely impact cognition (e.g., fewer educational opportunities, limited access to health care, food insecurity/poor nutrition, chronic stress, physical inactivity, less socialization, greater medical comorbidities). Future research will seek to investigate this further and to determine whether structural and functional alterations in the brain moderate the relationship between ADI and cognition. Funding: Cleveland Clinic Epilepsy Center