Active Seizures Predict Worse Instrumental Activities of Daily Living in Individuals With Normal Cognition and Dementia.

Objective: Cognitive disorders are common in older persons with seizures (PWS). Cognitive disorders are often associated with impaired Instrumental Activities of Daily Living (IADLs). However, the effects of seizures on IADLs remain unexplored. This study (9/2005-3/2024) from 42 US Alzheimer's Disease Research Centers examined baseline and longitudinal IADL decline in cognitively normal and cognitively impaired participants grouped as active seizures (past 12 months), remote seizures (history but none in 12 months), and controls (no seizures).

Methods: Pfeffer Functional Activities Questionnaire (FAQ) measured IADLs. ANOVA compared individual and total FAQ by seizure and cognitive status. Multivariable linear regression adjusted FAQ for seizure status, age, sex, and education. ANOVA compared the rate of longitudinal FAQ decline across seizure groups. Post hoc analyses identified group differences.

Results: Among 20,486 cognitively normal participants (average age = 69.7 years, female = 65% [N = 13,370]), IADLs were worse among 114 active seizure participants (adjusted-mean-difference [95% confidence interval (CI)]: active vs. remote = 0.69 (0.23, 1.14), p = 0.0011, active vs. controls = 0.85 (0.46, 1.24), p < 0.001). Among 30,238 cognitively impaired participants (average age = 72.2 years, female = 52% [N = 15,632]), IADLs were worse among 735 active seizure participants (adjusted-mean-difference (95% CI): active vs. remote = 6.85 (5.59, 8.10), p < 0.001, active vs. controls = 8.93 (8.06, 9.80), p < 0.001). Longitudinally, IADLs in cognitively normal adults declined faster in active seizure participants than in controls (p = 0.0396). Active seizure participants struggled most with managing taxes, traveling, paying bills, and remembering appointments.

Conclusions: Active seizures are associated with worse baseline IADLs and a faster rate of longitudinal decline in IADLs. These findings highlight the significant need to assess IADLs in routine clinical care in older PWS regardless of their cognition to identify those needing assistance.