Abstract Details

Title Association Between Post-stroke Epilepsy and Dementia Risk: Results from the Atherosclerosis Risk in Communities (ARIC) Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S25 - Emerging Stroke Therapies and Risk Stratification (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Objective

To estimate the risk of dementia associated with post-stroke epilepsy.

Background

Cognitive impairment and dementia are leading causes of post-stroke disability, and are also associated with epilepsy. However, the risk of dementia associated with post-stroke epilepsy is unknown.

Design/Methods

Data from 14,493 Atherosclerosis Risk in Communities (ARIC) Study participants without stroke or dementia at baseline (1987–1989) were analyzed through December 31, 2022. Adjudicated stroke and International Classification of Diseases Ninth/Tenth Revisions (ICD-9/10) code-defined epilepsy events were modeled as a 4-level time-varying exposure (no stroke/no epilepsy; stroke only; epilepsy only; post-stroke epilepsy). Adjudicated dementia was defined using data from neuropsychological tests, informant interviews, hospitalization ICD-9/10 and death certificate codes. Fine and Gray proportional hazards models adjusted for sociodemographics and vascular risk factors to account for the competing risk of death were used to estimate the risk of dementia associated with post-stroke epilepsy.

Results

At study baseline, the mean age of participants was 54.3 years, 55% were female, and 27% were of Black race. Over a median of 26 years, 1,191 (8.2%) patients had an incident stroke, 759 (5.2%) patients developed epilepsy, and 139 (1.0%) patients developed post-stroke epilepsy. A total of 3,697 incident dementia cases occurred over a total of 317,796 person-years of follow-up. The risk of dementia in the post-stroke epilepsy group was 2.43 times (95%CI=1.96-3.02) the risk of dementia in the no stroke/no epilepsy group. The risk of dementia among individuals with post-stroke epilepsy was also significantly higher compared to the stroke only (HR=2.04, 95%CI=1.61-2.58) and epilepsy only (HR=1.63, 95%CI=1.28-2.07) groups.

Conclusions

The risk of dementia was increased after post-stroke epilepsy compared no stroke and no epilepsy and compared to stroke alone and epilepsy alone. This work identifies individuals with post-stroke epilepsy as a high-risk subpopulation that may benefit from closer clinical monitoring for cognitive changes.

Authors/Disclosures
Andrea L. Schneider, MD, PhD (University of Pennsylvania) PRESENTER	Dr. Schneider has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN - Neurology.
Asma Akbar Ladak, MBBS	Ms. Ladak has nothing to disclose.
Jiping Zhou, MD, MPH	Dr. Zhou has nothing to disclose.
Connor A. Law, BS	Mr. Law has nothing to disclose.
Michelle C. Johansen, MD	Dr. Johansen has received research support from NINDS/NIA. Dr. Johansen has received research support from American Heart Association.
Anny Reyes, PhD (University of California, San Diego)	The institution of Dr. Reyes has received research support from National Institutes of Health. The institution of Dr. Reyes has received research support from American Epilepsy Society.
Silvia Koton, PhD, RN	Prof. Koton has nothing to disclose.
Juebin Huang, MD, PhD (University of Mississippi Medical Center)	Dr. Huang has nothing to disclose.
Kamakshi Lakshminarayan, MD, PhD (University of Minnesota)	Dr. Lakshminarayan has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ABBOTT Labs. The institution of Dr. Lakshminarayan has received research support from NIH.
Rebecca F. Gottesman, MD, PhD (Johns Hopkins University)	The institution of Dr. Gottesman has received research support from NIH.
Emily Johnson, MD (Johns Hopkins Epilepsy Center)	Dr. Johnson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EpiWatch. Dr. Johnson has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Johnson has received research support from NIH.

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