COGNIÇÃO E EPILEPSIA: TESTE DE TRIAGEM COGNITIVA

Tedrus, Glória Maria Almeida Souza; Passos, Maria Lina Giacomino Almeida; Vargas, Letícia Muniz; Menezes, Larissa Estela Ferreira Jacó

doi:10.1590/1980-57642020dn14-020013

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 14 (2) • Apr-Jun 2020 • https://doi.org/10.1590/1980-57642020dn14-020013 copiar

COGNIÇÃO E EPILEPSIA: TESTE DE TRIAGEM COGNITIVA

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO.

É frequente a ocorrência de déficits cognitivos em pessoas com epilepsia (PWE). Entretanto, no Brasil, as PWE podem ficar sem avaliação neurocognitiva pelo reduzido número de testes disponíveis e validados para nossa cultura e pela ausência de equipes multidisciplinares em ambulatórios gerais de epilepsia.

Objetivo:

Relacionar os escores do Brief Cognitive Battery-Edu (BCB-Edu) aos aspectos da epilepsia de 371 PWE.

Métodos:

Foi feita avaliação clínica e cognitiva (MMSE, BCB-Edu) de 371 PWE com idade > 18 anos. Foram relacionados os aspectos da epilepsia com os dados do BCB-Edu. Os dados cognitivos foram comparados aos de 95 indivíduos normais (NC), com p<0.05.

Resultados:

PWE apresentam desempenho cognitivo inferior ao do grupo NC. Os aspectos cognitivos foram distintos, segundo aspectos da epilepsia. Na regressão logística, os fatores preditivos para comprometimento em múltiplos domínios cognitivos foram a idade e a utilização de mais de uma droga antiepiléptica (R² Nagelkerke=0.135).

Conclusão:

Houve, nas PWE, pior desempenho cognitivo em diferentes domínios. Houve relação entre déficit cognitivo com aspectos da epilepsia. O BCB-Edu mostrou-se eficaz como teste de triagem cognitiva na epilepsia em adultos.

Palavras-chave:
epilepsia; Brief Cognitive Battery-Edu; cognição

	Genetic	Focal unknown etiology	Focal structural	p
Sex: Female/ Male	13/9	58/63	110/190	0.607^a a Chi-square test;
Age (years)	28.5 (±12.1)	47.2 (±16)	51.3 (±15.8)	<0.000^b b Kruskall-Wallis; ^* * p<0.05.
Age at onset (years)	14 (±3.7)	26.1 (±19.7)	28.6 (±21.8)	0.039^b b Kruskall-Wallis; ^* * p<0.05.
Antiepileptic drugs: 1/ ≥2	18/4	86/35	133/95	0.012^a a Chi-square test; ^* * p<0.05.
Seizure frequency: with seizure / controlled	7/15	48/73	96/132	0.619^a a Chi-square test;
EA laterality: right/ left	-	42/49	84/101	0.963^a a Chi-square test;

		PWE (n=371)	NC (n=95)	P	TLE-HS (n=113)	NC (n=95)	p	Epileptic syndrome
		PWE (n=371)	NC (n=95)	P	TLE-HS (n=113)	NC (n=95)	p	Genetic	Unknown etiology	Structural	p
Age (years)		48.6 (±16.5)	48.5 (±10.4)	0.164^a a t-test;	48.3 (±13.4)	48.5 (±10.4)	0.881^a a t-test;	28.5 (±12.1)	47.2 (±16.0)	51.3 (±15.8)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
Educational level (years)		5.7 (±3.8)	6.4 (±3.3)	0.074^a a t-test;	5.5 (±3.5)	6.4 (±3.3)	0.029^* * p<0.05. ^a a t-test;	8.6 (±3.4)	6.5 (±3.5)	5.0 (±3.8)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
MMSE		23.1 (±4.1)	24.7 (±2.6)	<0.001^* * p<0.05. ^a a t-test;	22.8 (±4.5)	24.7 (±2.6)	<0.001^* * p<0.05. ^a a t-test;	25.1 (±3.8)	24 (±3.3)	22.5 (±4.4)	0.002^* * p<0.05. ^b b Kruskall-Wallis;
BCB-Edu	• Identification	9.8 (±0.7)	9.9 (±0.2)	0.005^* * p<0.05. ^a a t-test;	9.9 (±0.2)	9.9 (±0.2)	0.723^a a t-test;	10.0 (±0.0)	9.8 (±0.7)	9.8 (±0.8)	0.370^b b Kruskall-Wallis;
	- Naming	9.7 (±1.0)	9.8 (±0.5)	0.173^a a t-test;	9.8 (±0.3)	9.8 (±0.5)	0.423^a a t-test;	10.0 (±0.0)	9.8 (±0.7)	9.6 (±1.2)	0.094^b b Kruskall-Wallis;
	• Incidental memory	5.8 (±1.8)	6.1 (±1.6)	0.086^a a t-test;	5.8 (±1.6)	6.1 (±1.6)	0.276^a a t-test;	6.4 (±1.8)	6.0 (±1.7)	5.6 (±1.8)	0.045^* * p<0.05. ^b b Kruskall-Wallis;
	• Immediate memory	7.3 (±1.9)	8.2 (±1.4)	<0.001^* * p<0.05. ^a a t-test;	7.3 (±1.8)	8.2 (±1.4)	<0.001^* * p<0.05. ^a a t-test;	8.7 (±1.1)	7.5 (±1.8)	7.0 (±1.9)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
	- Learning test	7.7 (±1.9)	8.9 (±1.1)	<0.001^* * p<0.05. ^a a t-test;	7.7 (±1.7)	8.9 (±1.1)	<0.001^* * p<0.05. ^a a t-test;	8.6 (±1.8)	8.2 (±1.7)	7.4 (±2.0)	<0.001^* * p<0.05. ^b b Kruskall-Wallis;
	- Delayed recall	6.7 (±2.1)	8.1 (±1.5)	<0.001^* * p<0.05. ^a a t-test;	6.7 (±1.9)	8.1 (±1.5)	<0.001^* * p<0.05. ^a a t-test;	8.0 (±1.7)	7.0 (±2.0)	6.4 (±2.2)	0.003^* * p<0.05. ^b b Kruskall-Wallis;
	- Recognition	9.1 (±1.6)	9.6 (±1.1)	<0.001^* * p<0.05. ^a a t-test;	9.3 (±1.2)	9.6 (±1.1)	0.037^* * p<0.05. ^a a t-test;	9.6 (±0.7)	9.2 (±1.4)	8.9 (±1.8)	0.031^* * p<0.05. ^b b Kruskall-Wallis;
Clock Drawing Test		5.6 (±2.8)	6.9 (±2.5)	<0.001^* * p<0.05. ^a a t-test;	5.7 (±2.7)	6.9 (±2.5)	0.001^* * p<0.05. ^a a t-test;	7.3 (±2.6)	6.0 (±2.5)	5.1 (±2.9)	0.001^* * p<0.05. ^b b Kruskall-Wallis;
SVF test		11.2 (±4.8)	12 (±4.8)	0.173^a a t-test;	10.7 (±4.3)	12 (±4.8)	0.045^* * p<0.05. ^a a t-test;	12.7 (±5.1)	12.3 (±4.8)	10.5 (±4.6)	0.001^* * p<0.05. ^b b Kruskall-Wallis;
PVF (F)		4.9 (±3.9)	7.7 (±5.4)	<0.001^* * p<0.05. ^a a t-test;	4.4 (±3.0)	7.7 (±5.4)	<0.001^* * p<0.05. ^a a t-test;	5.6 (±3.6)	5.7 (±4.2)	4.5 (±3.7)	0.020^* * p<0.05. ^b b Kruskall-Wallis;
PVF (A)		4.3 (±3.5)	7.0 (±4.7)	<0.001^* * p<0.05. ^a a t-test;	3.9 (±2.7)	7.0 (±4.7)	<0.001^* * p<0.05. ^a a t-test;	4.5 (±3.9)	5.2 (±3.7)	3.8 (±3.3)	0.003^* * p<0.05. ^b b Kruskall-Wallis;
PVF (S)		4.2 (±3.5)	7.2 (±5.1)	<0.001^* * p<0.05. ^a a t-test;	3.8 (±2.6)	7.2 (±5.1)	<0.001^* * p<0.05. ^a a t-test;	5.1 (±3.9)	5.0 (±3.8)	3.8 (±3.1)	0.024^* * p<0.05. ^b b Kruskall-Wallis;

		No cognitive impairment (n=133)	Impairment in multiple cognitive domains (n=238)	p-value
Age (years)		44.1 (±15.0)	51.1 (±16.9)	<0.001^* * p<0.05. ^a a t-test;
Educational level (years)		6.8 (±3.6)	5.0 (±3.7)	<0.001^* * p<0.05. ^a a t-test;
Age at onset (years)		23.2 (±15.9)	28.9 (±22.6)	0.005^* * p<0.05. ^a a t-test;
Duration of epilepsy (years)		20.9 (±15.3)	22.2 (±17.1)	0.459^a a t-test;
Sex	Female	76 (41.9%)	105 (58%)	0.016^* * p<0.05. ^b b Fisher's exact test;
Sex	Male	57 (30%)	133 (70%)
Antiepileptic drugs	1	94 (70.6%)	39 (29.3%)	0.042^* * p<0.05. ^b b Fisher's exact test;
Antiepileptic drugs	≥2	143 (60%)	95 (39.9%)
Epileptic syndrome	Genetic	12 (54.5%)	10 (45.4%)	0.002^* * p<0.05. ^c c Chi-square test;
	Focal unknown etiology	55 (45.4%)	66 (55.4%)
	Focal structural	66 (28.9%)	162 (71%)
Epilepsy	TLE-HS (113)	39 (34.5%)	74 (65.4%)	0.037^* * p<0.05. ^c c Chi-square test;
Epilepsy	Unknown etiology and genetic	68 (47.5%)	75 (52.4%)
TLE-HS laterality	Right (n=50)	20 (40%)	30 (60%)	0.261^b b Fisher's exact test;
TLE-HS laterality	Left (n=56)	18 (32.1%)	38 (67.8%)

		Age		Age at onset		Duration of epilepsy
		Correlation	p-value	Correlation	p-value	Correlation	p-value
MMSE		-0.190	<0.001^* * p<0.05.	-0.012	0.822	-0.174	0.001^* * p<0.05.
BCB-Edu	Identification	-0.155	0.003^* * p<0.05.	-0.098	0.061	-0.032	0.542
	Naming	-0.170	0.001^* * p<0.05.	-0.122	0.019^* * p<0.05.	-0.017	0.743
	Incidental memory	-0.388	<0.001^* * p<0.05.	-0.291	<0.001^* * p<0.05.	-0.029	0.573
	Immediate memory	-0.345	<0.001^* * p<0.05.	-0.185	<0.001^* * p<0.05.	-0.115	0.028^* * p<0.05.
	Learning test	-0.308	<0.001^* * p<0.05.	-0.218	<0.001^* * p<0.05.	-0.035	0.506
	Delayed recall	-0.231	<0.001^* * p<0.05.	-0.190	<0.001^* * p<0.05.	0.004	0.943
	Recognition	-0.308	<0.001^* * p<0.05.	-0.223	<0.001^* * p<0.05.	-0.031	0.548
Clock Drawing Test		-0.220	<0.001^* * p<0.05.	-0.069	0.200	-0.133	0.013^* * p<0.05.
SVF test		-0.180	<0.001^* * p<0.05.	-0.099	0.058	-0.060	0.254
PVF (F)		-0.119	0.023^* * p<0.05.	-0.002	0.965	-0.118	0.025^* * p<0.05.
PVF (A)		-0.064	0.223	-0.007	0.894	-0.058	0.273
PVF (S)		-0.101	0.053	-0.016	0.756	-0.082	0.121

Test	Variables in equation	Beta coefficient	SE	95% CI for coefficient	p
Immediate memory^a a R2 Nagelkerke=0.130;	Age	0.035	0.011	1.015 1.057	0.001*
Immediate memory^a a R2 Nagelkerke=0.130;	Educational level (years)	-0.091	0.046	0.825 0.999	0.047*
Learning test^b b R2 Nagelkerke=0.119;	Age	0.027	0.010	1.008 1.047	0.005*
Learning test^b b R2 Nagelkerke=0.119;	Educational level (years)	-0.104	0. 042	0.830 0.978	0.013*
Delayed recall^c c R2 Nagelkerke=0.109;	Educational level (years)	-0.114	0.036	0.831 0.958	0.002*
	Age at onset	0.015	0.006	1.003 1.027	0.017*
	AED: 1/ ≥2	-0.785	0.268	0.270 0.771	0.003*
Recognition^d d R2 Nagelkerke=0.124;	Age	0.030	0.010	1.011 1.052	0.003*
Recognition^d d R2 Nagelkerke=0.124;	Educational level (years)	-0.102	0.045	0.827 0.986	0.022*
SVF test^e e R2 Nagelkerke=0.169;	Educational level (years)	-0.186	0.032	0.780 0.884	<0.001*
SVF test^e e R2 Nagelkerke=0.169;	AED: 1/ ≥2	-0.740	0.255	0.289 0.787	0.004*
Impairment in multiple cognitive domains ^f f R2 Nagelkerke =0.072.	Age	0.026	0.006	1.007 1.046	0.006*
	AED: 1/ ≥2	-0.628	0.285	0.035 0.934	0.028*

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E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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