Assessment of cognitive status in optimization of personalized therapy programs for patients with epilepsy

Assessment of cognitive status in optimization of personalized therapy programs for patients with epilepsy

 

Authors

 

V.A. Mikhailov

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

O.N. Yakunina

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

N.I. Shova

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

S.A. Korovina

Federal State Budgetary Institution “V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology” of the Ministry of Health of the Russian Federation, St. Petersburg, Russian Federation

 

https://doi.org/10.26617/1810-3111-2024-3(124)-79-87

 

Journal: Siberian Herald of Psychiatry and Addiction Psychiatry. 2024; 3 (124):  79-87.

 

Abstract

Background. Complaints about intellectual and mental disorders (speech functions, memory, attention, thinking), which patients may present at a doctor's appointment, are in second place after complaints about seizure motor and sensory symptoms. Some studies show that 60% to 70% of people with epilepsy have cognitive impairment. Objective: to evaluate the features of cognitive functioning in patients with epilepsy using assessment scales and questionnaires. Materials and Methods. Examination and treatment of patients (n=458) with epilepsy were conducted, of which 123 had a disease duration from several weeks to 3 years, 250 more than 3 years, 85 with remission of epileptic seizures (the main group). As a control group, 40 practically healthy people matched in gender and age to patients of the main group were examined. During the anamnesis collection, information about the onset and progression of the disease and the results of clinical examinations were obtained. Content analysis was used to study the mental status and complaints based on the case histories. Experimental psychological methods for assessing the cognitive functions were used in psychological testing for diagnosing epilepsy: 1) Digital proofreading test (Amatuni V.N., 1969), 2) Memorizing 10 words (Luria A.R., 1973), 3) Assessment of visual retention (Benton A.L., 1942), 4) Exclusion of unnecessary item – accuracy of generalizations (Zeigarnik B.V., 1963), 5) The Intelligence Scale (WAIS, Wechsler D., 1955) and its individual subtests. Results. Compared to healthy respondents, epileptic patients spent more time completing the Digital Proofreading Test (754.60±48.96 versus 604.53±27.29 sec), remembered fewer presented words (36.40±1.30 versus 41.40±1.30) using the 10-word memorization technique, made more mistakes in general, errors of omission and deformation of figures using the Benton test, experienced difficulties in understanding the generic relationships between objects and selecting generalizing words, demonstrated pathological thoroughness (inertia and torpidity) using the Exclusion of an Extra Object technique, scored fewer points on the nonverbal (91.91±1.93 versus 101.00±1.06) and complete (101.57±2.08 versus 110.20±0.83) in the final statistical assessment, had a high percentage of assessments related to the low norm and level of mental defect, according to the Wechsler test. As the age of patients increased, the torpidity of mental activity increased a low level of active attention and memory, weakness of visual-motor coordination, a decrease in constructive skills and the ability for cognitive activity were noted. In patients with epilepsy, heterogeneous disorders of the cognitive domain, caused by the combined effect of clinical, psychological and social factors, were detected using a diagnostic psychological investigation. They were dynamic, the degree of their severity increased with the progressive course of the disease and smoothed out with an improvement in the patient’s well-being and the achievement of remission of seizures. Conclusions. The use of psychological and psychodiagnostic testing in the presence of a verified diagnosis of epilepsy should become a standard procedure in routine clinical practice to assess impairments of memory, attention, orientation, visual-spatial functions, speech, praxis and thinking in order to increase the effectiveness of therapy aimed at improving the quality of life of patients with epilepsy.

 

Keywords: epilepsy, cognitive impairment, diagnostics, psychological testing, nonpsychotic mental disorders, depression, insomnia, antiepileptic drugs.

 

Article (pdf)

 

Contacts

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Materials  

For citation: Mikhailov V.A., Yakunina O.N., Shova N.I., Korovina S.A. Assessment of cognitive status in optimization of personalized therapy programs for patients with epilepsy. Siberian Herald of Psychiatry and Addiction Psychiatry.2024; 3 (124): 79-87. https://doi.org/10.26617/1810-3111-2024-3(124)-79-87

 

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