Written by Being Patient

As people age, changes to their blood vessels caused by high blood pressure, cholesterol, or other cardiovascular risk factors, damages the brain and predisposes it to a variety of different diseases including dementia and epilepsy. 

In the U.S., epilepsy affects roughly three million adults and is a disorder characterized by recurrent seizures. Scientists have found that seizures can cause a build up of beta-amyloid plaques, making the brain more vulnerable to Alzheimer’s and other forms of dementia.

This is where things get complicated: While epilepsy may increase the risk of developing dementia, dementia may increase the risk of developing epilepsy, too — by as much as five to 10 times. 

Epilepsy and dementia are also easy to confuse for one another: Some types of seizures can cause temporary confusion and memory problems that look like dementia, which can lead to a misdiagnosis of mild cognitive impairment or dementia in people who only have epilepsy.

Epilepsy can speed up cognitive decline

According to research conducted by Dr. Irfah Zawar, a neurologist at the University of Virginia, Charlottesville, epilepsy speeds up cognitive decline. The study looked at 13,700 cognitively healthy participants over the course of 14 years, and about 1 percent of these participants had epilepsy. 

People with high cholesterol, blood pressure, or diabetes were even more likely to develop the cognitive impairment over a 14-year period. People with active epilepsy were also developing dementia several years earlier than people with epilepsy who were in remission and those who had never been diagnosed with epilepsy. 

Epilepsy can sometimes be confused for cognitive decline

Because of all this overlap, people living with a certain forms of epilepsy tend to get misdiagnosed with dementia. The key difference between epilepsy symptoms and dementia is that forgetfulness in people with epilepsy is very episodic. People with dementia or other forms of cognitive decline will be impaired throughout the entire day. People who have seizures when they wake up will return to their baseline cognitive function just minutes later.

How can doctors tell the difference between epilepsy and early signs of dementia?

It’s crucial to ensure that people receive an accurate diagnosis so that their underlying condition, whether it be MCI, dementia, or epilepsy is treated appropriately. 

Diagnosing dementia is complicated. It requires running blood tests and cognitive tests to rule out other conditions, and then testing for potential biomarkers in the brain to confirm a diagnosis for Alzheimer’s disease. Patients seldom receive electroencephalography (EEG), a non-invasive test that measures brain waves, which can spot epilepsy, which can sometimes explain cognitive decline or in other cases may co-occur with dementia.   

Since people aren’t being tested, Zawar told Being Patient that it can take several years for older adults to get an epilepsy diagnosis. 

To address these issues, she is researching new strategies and techniques to improve the diagnosis of epilepsy in people with dementia.