Idosos com epilepsia: queixa de memória e desempenho neuropsicológico objetivo

Avaliar a ocorrência de queixas de memória em idosos com epilepsia (IE) e se há associação com variáveis clínicas, desempenho cognitivo objetivo e qualidade de vida (QV).

Métodos:

O questionário de queixa de memória (memory complaint questionnaire — MAC-Q) foi relacionado ao desempenho cognitivo objetivo, o inventário de depressão de transtornos neurológicos para epilepsia (neurological disorders depression inventory for epilepsy — NDDI-E), o QOLIE-31 e com as características clínicas de 83 IE.

Resultados:

Houve desempenho cognitivo inferior e maiores escores no MAC-Q em IE quando comparados aos de um grupo controle similar (n=40). Comprometimento de múltiplos domínios cognitivos ocorreu em 34 (41%) IE e associou-se a maior idade e menor escolaridade. Queixas de memória (MAC-Q≥25) foram observadas em 45 (54,2%) IE e associadas a idade mais elevada, menor escolaridade, início das crises aos ≥60 anos, maiores escores no NDDI-E, menores escores no QOLIE-31 e comprometimento de múltiplos domínios cognitivos.

Conclusões:

Pior desempenho cognitivo e maiores queixa de memória ocorreram em IE. Crises com início aos ≥60 anos foram associadas a queixas, mas não a déficit objetivo cognitivo. Houve associação entre desempenho cognitivo subjetivo e objetivo, com aspectos da epilepsia e pior QV.

Palavras-chave:
Epilepsia; Memoria; Idoso

		OAE (n=83)	CG (n=40)	p-value
Gender: female/male		39/44	23/17	0.275^a a chi-square test;
Age (years)		68.4 (±7.0)	68.5 (±4.1)	0.974^b b Student's t-test;
Educational level (years)		3.9 (±3.3)	4.2 (±2.3)	0.534^b b Student's t-test;
MMSE (total score)		22.7 (±4.1)	24.9 (±3.0)	0.004^b b Student's t-test; ^* * p<0.05.
BCB-Edu
	Identification	9.6 (±1.0)	9.9 (±0.1)	0.050^b b Student's t-test;
	Naming	9.4 (±1.5)	9.8 (±0.4)	0.029^b b Student's t-test; ^* * p<0.05.
	Incidental memory	5.2 (±1.5)	5.9 (±1.5)	0.022^b b Student's t-test; ^* * p<0.05.
	Immediate memory	6.6 (±1.7)	7.7 (±1.6)	0.001^b b Student's t-test; ^* * p<0.05.
	Learning test	7.1 (±1.8)	8.0 (±1.3)	0.010^b b Student's t-test; ^* * p<0.05.
	Delayed recall	6.4 (±1.3)	7.6 (±2.0)	0.001^b b Student's t-test; ^* * p<0.05.
	Recognition	8.1 (±2.5)	9.2 (±2.2)	0.017^b b Student's t-test; ^* * p<0.05.
	Clock drawing test	4.7 (±2.8)	6.3 (±2.6)	0.003^b b Student's t-test; ^* * p<0.05.
	SVF test	10.4 (±4.6)	12.9 (±5.1)	0.010^b b Student's t-test; ^* * p<0.05.
	MAC-Q	25.9 (±5.4)	24.0 (±3.9)	0.034^b b Student's t-test; ^* * p<0.05.
Age at first seizure (years)		46.8 (±23.4)
Average epilepsy duration (years)		21.7 (±20.9)
Seizure onset: <60/≥60 years		54/ 29
QOLIE-31 (total score)		67.7 (±16.8)
NDDI-E		10.9 (±4.6)
NDDI-E>15		13 (15.6%)

	Age	Age at first seizure	MAC-Q	NDDI-E
MAC-Q	0.331^* * p<0.05;	0.260^* * p<0.05;
NDDI-E	0.284^* * p<0.05;	0.141	0.268^* * p<0.05;
MMSE	-0.224^* * p<0.05;	-0.086	-0.316^* * p<0.05;	-0.219^* * p<0.05;
Clock drawing test	-0.218^* * p<0.05;	0.064	-0.140	-0.141
SVF test	-0.054	-0.113	-0.212	-0.137
Identification	-0.343^* * p<0.05;	-0.233^* * p<0.05;	-0.102	-0.335^* * p<0.05;
Naming	-0.228^* * p<0.05;	0.083	0.039	-0.395^* * p<0.05;
Incidental memory	-0.432^ p<0.001.	-0.256^* * p<0.05;	-0.312^* * p<0.05;	-0.240^* * p<0.05;
Immediate memory	-0.530^* * p<0.05;	-0.189	-0.280^* * p<0.05;	-0.295^* * p<0.05;
Learning test	-0.440^* * p<0.05;	-0.267^* * p<0.05;	-0.290^* * p<0.05;	-0.332^* * p<0.05;
Delayed recall	-0.305^* * p<0.05;	-0.102	-0.205	-0.181
Recognition	-0.426^* * p<0.05;	-0.156	-0.244^* * p<0.05;	-0.186

		MAC-Q			Cognitive impairment
		≤25 (n=38)	>25 (n=45)	p-value	No (n=49)	Yes (n=34)	p-value
Gender: female/male		14/24	25/20	0.089^a a chi-square test;	23/26	16/18	0.991^a a chi-square test;
Age (years)		65.8 (±4.9)	70.5 (±7.8)	0.002^b b t-test; ^* * p<0.05.	66.2 (±5.2)	71.5 (±8.0)	0.001^b b t-test; ^* * p<0.05.
Educational level (years)		4.6 (±3.1)	2.9 (±2.5)	0.013^b b t-test;	4.6 (±3.1)	2.4 (±2.0)	<0.000^b b t-test; ^* * p<0.05.
Age at first seizure (years)		40.2 (±22.7)	52.3 (±22.7)	0.018^b b t-test; ^* * p<0.05.	42.8 (±20.8)	52.5 (±25.9)	0.077^b b t-test;
Seizure onset: <60/ ≥60		29/9	25/20	0.048^a a chi-square test;	36/13	18/16	0.054^a a chi-square test;
Epilepsy duration (years)		25.6 (±21.8)	18.4 (±19.8)	0.120^b b t-test;	23.5 (±20.4)	19.0 (±21.8)	0.345^b b t-test;
Seizures in the previous year: yes/no		20/18	18/27	0.205^a a chi-square test;	24/25	14/20	0.510^c c Fisher's exact test;
EA laterality: right/left		16/15	19/16	0.828^a a chi-square test;	23/18	12/13	0.614^a a chi-square test;
Number of AEDs taken: 1/≥2		19/19	29/16	0.265^c c Fisher's exact test;	25/24	23/11	0.176^c c Fisher's exact test;
Structural epilepsy/unknown etiology		27/11	34/11	0.803^a a chi-square test;	32/17	29/5	0.048^a a chi-square test; ^* * p<0.05.
QOLIE-31
	Emotional well-being	76.8 (±16.7)	62.3 (±26.3)	0.010^b b t-test; ^* * p<0.05.	64.0 (±24.7)	74.6 (±21.6)	0.080^b b t-test;
	Cognitive functioning	79.0 (±19.4)	61.1 (±25.2)	0.002^b b t-test; ^* * p<0.05.	65.6 (±26.9)	72.4 (±20.0)	0.259^b b t-test;
	Total score	74.1 (±11.7)	63.6 (±18.4)	0.007^* * p<0.05.	65.7 (±17.1)	70.9 (±16.1)	0.219^b b t-test;
	NDDI-E	9.5 (±4.4)	12.1 (±4.8)	0.013^b b t-test; ^* * p<0.05.	9.8 (±4.2)	12.5 (±5.2)	0.014^b b t-test; ^* * p<0.05.
Cognitive impairment: no/yes		27/11	22/23	0.047^a a chi-square test; ^* * p<0.05.

	Predictor	Odds ratio	95%CI	p-value
Impairment in multiple cognitive domains	Age	1.11	1.10 1.22	0.016^* * p<0.05.
Impairment in multiple cognitive domains	Educational level	0.78	0.62 0.64	0.016^* * p<0.05.
MAC-Q	Age	1.12	1.04 1.23	0.005^* * p<0.05.

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[1] Correspondence: Gloria Tedrus, Email: gmtedrus@uol.com.br