Approximately 25-50% of epilepsy cases with elderly-onset do not have a clear etiology. Large database studies have identified LOUE as a risk factor for dementia, however the cognitive profile and trajectory of LOUE have not been well-described.

Patients were recruited from Brigham and Women’s Hospital and affiliated hospitals. Inclusion criteria: new onset seizures >60yo, onset <3 years, absence of cortical lesions on MRI and of provoking factors. Patients underwent the Clinical Dementia Rating (CDR) Scale and a neuropsychological battery to assess 4 cognitive domains: global cognition (Preclinical Alzheimer Cognitive Composite), delayed verbal recall (Free and Cued Selective Reminding Test and Logical Memory), processing speed (Trailmaking Test A, Digit Symbol Substitution Test), and executive function (Trailmaking Test B and Controlled Oral Word Association Test). Performances were normalized to generate z-scores.

Patients with LOUE exhibit mild deficits across multiple cognitive domains around the time of epilepsy diagnosis. Our future directions include characterization of the underlying factors and the natural history of LOUE.