Cognitive and neuropsychiatric outcomes in economically active young patients with epilepsy: a case-control study from a secondary medical center in Mexico

Abstract

Aim:Epilepsy is associated with cognitive and neuropsychiatric impairments, affecting attention, memory, executive functions, and emotional well-being. While these impairments are well-documented in general epilepsy populations, limited research focuses on economically active young adults who face unique cognitive demands in competitive academic and professional environments. The objective of this research was to evaluate the cognitive and neuropsychiatric outcomes in economically active young adults with epilepsy compared to matched controls.
Methods:An observational, analytical, case-control study was conducted at a secondary medical center in Mexico. Participants included 25 patients with well-controlled epilepsy and 25 matched controls. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and Addenbrooke’s Cognitive Examination III (ACE-III). Anxiety and depression were evaluated using the Beck Anxiety Inventory and Patient Health Questionnaire-9 (PHQ-9). Statistical analysis included Student’s T-test and Chi-square for cognitive scores and Wilcoxon rank-sum tests for non-parametric data.
Results:Cognitive impairments were significantly more frequent in patients with epilepsy than in controls, particularly in attention (p = 0.041), episodic memory (p = 0.048), clock drawing (p = 0.004), and cube copying (p ＜ 0.001). Verbal (p = 0.011) and semantic fluency (p = 0.027) were also affected. No significant differences were observed in anxiety (p = 0.221) or depression (p = 0.800) between groups.
Conclusions:Economically active young adults with well-controlled epilepsy showed significant cognitive impairments, particularly in attention, memory, visuospatial, and executive functions, independent of anxiety and depression levels. This study underscores the need for comprehensive cognitive and neuropsychiatric evaluations in epilepsy treatment, regardless of seizure control. It advocates for targeted cognitive rehabilitation and a holistic approach to epilepsy care beyond seizure frequency control.

Keywords

Epilepsy / anxiety / depression / cognitive impairment

References

[1] Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia. 2014; 55: 475-82.

[2] Witt JA, Helmstaedter C. Cognition in epilepsy: current clinical issues of interest. Curr Opin Neurol. 2017; 30: 174-9.

[3] Kanner AM, Helmstaedter C, Sadat-Hossieny Z, Meador K. Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations. Seizure. 2020; 83: 216-22.

[4] Paredes-Aragón E, Ruiz-Garcia R, Burneo JG. Depression in patients with epilepsy. Pathophysiological and clinical concepts and therapeutic strategies. Rev Neurol. 2023; 76: 137-46. Spanish.

[5] Fiest KM, Dykeman J, Patten SB, Wiebe S, Kaplan GG, Maxwell CJ, et al. Depression in epilepsy: A systematic review and meta-analysis. Neurology. 2013; 80: 590-9.

[6] Yang Y, Yang M, Shi Q, Wang T, Jiang M. Risk factors for depression in patients with epilepsy: A meta-analysis. Epilepsy Behav. 2020; 106: 107030.

[7] Operto FF, Pastorino GMG, Viggiano A, Dell’Isola GB, Dini G, Verrotti A, et al. Epilepsy and Cognitive Impairment in Childhood and Adolescence: A Mini-Review. Curr Neuropharmacol. 2023; 21: 1646-65.

[8] Arslan G, Demir B. Cognitive impairment in epilepsy patients and its correlations. Appl Neuropsychol Adult. 2024; 31: 1405-10.

[9] Tabibian F, Mehvari Habibabadi J, Maracy MR, Kahnouji H, Rahimi M, Rezaei M. Evaluation of Cognitive Impairment in Refractory Temporal Lobe Epilepsy Patients Concerning Structural Brain Lesions. Basic Clin Neurosci. 2023; 14: 385-95.

[10] Bogut L, Andersen K, Grejsen J, Gimenez-Rico MJM, Debes NMM. Decreased Cognitive Function in Danish Children with Epilepsy. Neuropediatrics. 2023; 54: 328-34.

[11] Galioto R, Thamilavel S, Blum AS, Tremont G. Awareness of cognitive deficits in older adults with epilepsy and mild cognitive impairment. J Clin Exp Neuropsychol. 2015; 37: 785-93.

[12] Reséndiz-Aparicio JC. Guías clínicas del Programa Prioritario de Epilepsia del Sector Salud, México. Rev Mex Neuroscience. 2023; 20: 2376.

[13] Padrós Blázquez F, Montoya Pérez KS, Bravo Calderón MA, Martínez Medina MP. Propiedades psicométricas del Inventario de Ansiedad de Beck (BAI, Beck Anxiety Inventory) en población general de México. Ansiedad Estrés. 2020; 26: 181-7.

[14] Levis B, Benedetti A, Thombs BD; DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis. BMJ. 2019; 365: l1476.

[15] Montaño-Lozada JM, López N, Espejo-Zapata LM, Soto-Añari M, Ramos-Henderson M, Caldichoury-Obando N, et al. Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation. Epilepsy Behav. 2021; 122: 108158.

[16] Novak A, Vizjak K, Gacnik A, Rakusa M. Cognitive impairment in people with epilepsy: Montreal Cognitive Assessment (MoCA) as a screening tool. Acta Neurol Belg. 2023; 123: 451-6.

[17] Adaptación cultural, validez aparente y confiabilidad del instrumento Addenbookr’s Cognitive Examination III para el tamizaje del trastorno neurocognitivo mayor en pacientes del programa GERIATRIMSS del Hospital General de Zona No. 1 del IMSS de Aguascalientes [Internet]. c2002-2012 [cited 2020 Feb 13]. Available from: http://hdl.handle.net/11317/1850

[18] Schlesselman JJ. SAMPLE SIZE REQUIREMENTS IN COHORT AND CASE-CONTROL STUDIES OF DISEASE. Am J Epidemiol. 1974; 99: 381-4.

[19] Manole AM, Sirbu CA, Mititelu MR, Vasiliu O, Lorusso L, Sirbu OM, et al. State of the Art and Challenges in Epilepsy-A Narrative Review. J Pers Med. 2023; 13: 623.

[20] Celiker Uslu S, Yuksel B, Tekin B, Sariahmetoglu H, Atakli D. Cognitive impairment and drug responsiveness in mesial temporal lobe epilepsy. Epilepsy Behav. 2019; 90: 162-7.

[21] Poch C, Toledano R, García-Morales I, Prieto A, García-Barragán N, Aledo-Serrano Á, et al. Mnemonic discrimination in patients with unilateral mesial temporal lobe epilepsy relates to similarity and number of events stored in memory. Neurobiol Learn Mem. 2020; 169: 107177.

[22] Batchelor R, Taylor MD. Young adults with epilepsy: Relationships between psychosocial variables and anxiety, depression, and suicidality. Epilepsy Behav. 2021; 118: 107911.

[23] Badawy RA, Johnson KA, Cook MJ, Harvey AS. A mechanistic appraisal of cognitive dysfunction in epilepsy. Neurosci Biobehav Rev. 2012; 36: 1885-96.

[24] Holmes GL. Cognitive impairment in epilepsy: the role of network abnormalities. Epileptic Disord. 2015; 17: 101-16.

[25] Zhang Z, Lu G, Zhong Y, Tan Q, Yang Z, Liao W, et al. Impaired attention network in temporal lobe epilepsy: A resting FMRI study. Neurosci Lett. 2009; 458: 97-101.

[26] Holmes GL, Lenck-Santini PP. Role of interictal epileptiform abnormalities in cognitive impairment. Epilepsy Behav. 2006; 8: 504-15.

[27] Jefferys JGR, Jiruska P, de Curtis M, Avoli M. Limbic Network Synchronization and Temporal Lobe Epilepsy. In: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, editors. Jasper’s Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD): National Center for Biotechnology Information (US); 2012.

[28] Piper RJ, Richardson RM, Worrell G, Carmichael DW, Baldeweg T, Litt B, et al. Towards network-guided neuromodulation for epilepsy. Brain. 2022; 145: 3347-62.

[29] Hüsser AM, Vannasing P, Tremblay J, Osterman B, Lortie A, Diadori P, et al. Brain language networks and cognitive outcomes in children with frontotemporal lobe epilepsy. Front Hum Neurosci. 2023; 17: 1253529.

[30] Landi S, Petrucco L, Sicca F, Ratto GM. Transient Cognitive Impairment in Epilepsy. Front Mol Neurosci. 2019; 11: 458.

[31] Kramer MA, Cash SS. Epilepsy as a Disorder of Cortical Network Organization. Neuroscientist. 2012; 18: 360-72.

[32] Besag FMC, Vasey MJ. Neurocognitive Effects of Antiseizure Medications in Children and Adolescents with Epilepsy. Paediatr Drugs. 2021; 23: 253-86.

[33] Mukhtar I. Unravelling the critical role of neuroinflammation in epilepsy-associated neuropsychiatric comorbidities: A review. Prog Neuropsychopharmacol Biol Psychiatry. 2025; 136: 111135.

[34] Aliyianis TS, Winston GP. The impact of cognitive impairment due to epilepsy on quality of life: What do we know? Epilepsy Res. 2025; 215: 107592.