Neuropsychiatric Symptoms of Epilepsy

Chapter 14
Dementia
Alla Guekht
Abstract Association between epilepsy and dementia has been described centuries
ago; still many neurobiological, clinical, and therapeutic issues remain unclear. This
comorbidity is currently in the focus of experimental, translational, and clinical
research.
There are similarities (as well as differences) between patients with dementias
and those with temporal lobe epilepsy (TLE), and between animal models of
Alzheimer disease (AD) and TLE. Seizures in the human temporal lobe transiently
impair cognition and steadily damage hippocampal circuitry, leading to progressive
memory loss; many mechanisms involved in AD influence excitability and cause
seizures.
On one hand, there is a multifactorial cognitive deficit in patients with chronic
epilepsy; it is driven by the impact of the underlying etiology, the effects of recurrent
seizures, adverse effects of antiepileptic drugs (AEDs), and psychosocial
issues.
On the other hand, seizures are frequently observed in patients with dementia.
The incidence of seizures among patients with dementia varies with the etiology of
the dementing illness.
The proper choice of AEDs is essential in symptomatic treatment of seizures in
patients with dementia; possible risks and benefits of the drug for the elderly patient
should be noted.
Better understanding of the converging neurobiological pathways of epilepsy
and dementia could enrich the therapeutic armamentarium and allow improved control
of both conditions, ameliorate related abnormalities and potentially modify disease
progression.
Keywords Epilepsy • Seizures • Cognitive decline • Alzheimer’s disease • Vascular
dementia • Apolipoprotein E • β-amyloid • Hippocampal sclerosis • Excitotoxicity •
Antiepileptic drugs
A. Guekht , MD, PhD
Department of Neurology, Neurosurgery and Genetics , Russian National Research Medical
University and Moscow Research and Clinical Center for Neuropsychiatry , Donskaya, 43 ,
Moscow 115419 , Russia
e-mail: guekht@gmail.com
© Springer International Publishing Switzerland 2016
M. Mula (ed.), Neuropsychiatric Symptoms of Epilepsy, Neuropsychiatric
Symptoms of Neurological Disease, DOI 10.1007/978-3-319-22159-5_14
235