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Cited by 125Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsEpilepsy research and treatment

Subclinical epileptiform activity accelerates the progression of Alzheimer’s disease: a long-term EEG study.

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Horvath, Andras Attila, Papp, Aniko, Zsuffa, Janos, Szucs, Anna, Luckl, Janos, Radai, Ferenc, Nagy, Ferenc, Hidasi, Zoltan +3 more·2021·Clinical Neurophysiology
DOI 10.1016/j.clinph.2021.03.050
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Abstract

OBJECTIVE: While many studies suggest that patients with Alzheimer's disease have a higher chance for developing epileptic seizures, only a few studies are available examining independent epileptic discharges. The major aims of our study was to determine the prevalence of subclinical epileptiform activity (SEA) in AD compared to healthy elderly controls with the hypothesis that SEA is more frequent in AD than in cognitively normal individuals. Another aim was to analyze the effect of baseline SEA captured with electroencephalography on the progression of the disease with longitudinal cognitive testing. METHODS: We investigated 52 Alzheimer patients with no history of epileptic seizures and 20 healthy individuals. All participants underwent a 24-hour electroencephalography, neurology, neuroimaging and neuropsychology examination. Two independent raters analyzed visually the electroencephalograms and both raters were blind to the diagnoses. Thirty-eight Alzheimer patients were enrolled in a 3-year long prospective follow-up study with yearly repeated cognitive evaluation. RESULTS: Subclinical epileptiform discharges were recorded significantly (p:0.018) more frequently in Alzheimer patients (54%) than in healthy elderly (25%). Epileptiform discharges were associated with lower performance scores in memory. Alzheimer patients with spikes showed 1.5-times faster decline in global cognitive scores than patients without (p < 0.001). The decline in cognitive performance scores showed a significant positive correlation with spike frequency (r:+0.664; p < 0.001). CONCLUSIONS: Subclinical epileptiform activity occurs in half of Alzheimer patients who have never suffered epileptic seizures. Alzheimer patients with subclinical epileptiform activity showed accelerated cognitive decline with a strong relation to the frequency and spatial distribution (left temporal) of spikes. SIGNIFICANCE: Our findings suggest the prominent role of epileptiform discharges in the pathomechanism of Alzheimer's disease which might serve as potential therapeutic target.

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  • In Alzheimer's disease, an estimated 60% of patients have seizures and subclinical epileptic activity.

    “In Alzheimer’s disease (AD), which is the most common tauopathy, an estimated 60% of patients have seizures and subclinical epileptic activity (Vossel et al., 2016, 2017; Lam et al., 2020; Horvath et al., 2021).”

    From Tauopathy and Epilepsy Comorbidities and Underlying Mechanisms (2022) · cites this paper as Horvath et al., 2021

    The Abstract reports subclinical epileptiform discharges in 54% of 52 Alzheimer’s patients, which is roughly consistent with the estimated 60%. But the study excluded patients with a history of seizures, so it does not establish a prevalence for seizures and subclinical activity together. Page numbers were not available in our copy. (LLM, conf=0.87)

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Authors
Horvath, A. A., Papp, A., Zsuffa, J., Szucs, A., Luckl, J., Radai, F., Nagy, F., Hidasi, Z., Csukly, G., Barcs, G., & Kamondi, A.
Affiliations
  • Semmelweis University (HU)
  • Somogy Megyei Kaposi Mór Oktató Kórház (HU)
Corresponding author
Horvath, Andras Attila
ORCID
Venue
Clinical Neurophysiology
Publisher
Elsevier BV
Published
2021-08
Volume
132
Issue
8
Pages
1982-1989
ISSN
1388-2457 (ISSN-L)
DOI
10.1016/j.clinph.2021.03.050
OpenAlex
W3163306446
Cited by
125
References
4
Citations by year
2026: 23 · 2025: 31 · 2024: 21 · 2023: 26 · 2022: 20 · 2021: 3
FWCI
12.55
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Neurophysiology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
Funders
  • National Key Research and Development Program of China (KTIA_NAP_13-1-2013-0001)
  • National Research, Development and Innovation Office (2019-2.1.7-ERA-NET-2020-00006)
  • EU Joint Programme – Neurodegenerative Disease Research
  • Magyar Tudományos Akadémia
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
Keywords
Alzheimer's disease, epileptiform discharges, cognitive decline, disease progression, EEG, memory impairment, seizure susceptibility, long-term follow-up
MeSH terms
Aged, Aged, 80 and over, Alzheimer Disease, Electroencephalography, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Seizures, Time Factors, Disease Progression

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