(595) Cognitive scores of Spanish-speaking people with epilepsy decline as a function of temporal lobe epilepsy duration

This abstract has been invited to present during the Better Patient Outcomes through Diversity Platform poster session

Rationale: To explore temporal lobe epilepsy (TLE) disease duration (DD) with cognitive performances across multiple domains in a unique, primarily immigrant, Spanish-speaking cohort living in the U.S.

Methods: Retrospective analysis of neuropsychological exams of Spanish-speaking people with intractable TLE was done to explore the relationship of DD of TLE with cognitive functioning. The Neuropsychological Screening Battery for Hispanics (Ponton, 1996) was part of a comprehensive presurgical evaluation. Intellect, attention, processing speed, language, visuospatial, visual memory, verbal learning and memory, executive functioning and fine motor dexterity were measured. Subtest raw scores were converted to z-scores using education-based normative data (Ponton, 2001). Pearson's correlations were used to explore the relationship of DD on cognitive performance. The cohort was divided into three DD groups; 1 - 20 years (G1, n = 8), 21 - 30 years (G2, n = 10), and 31+ years (G3, n = 8) allow ANOVA analyses to explore the impact on cognition across different DD subgroups.

Results: Spanish-speaking participants (n=26), mostly female (54%), had a mean age of 36-years and a mean reported level of education of eight years. Mean DD was 26.7 years. 

Pearson’s correlations yielded significant, negative correlations. Longer DD was associated with poorer neuropsychological performances across select cognitive domains. Specific domains and respective subtests included: Intelligence, (Raven’s Progressive Matrices - a nonverbal test of intelligence; r (24) = -0.54, p < 0.01); Processing Speed (Color Trails 1, r (24) = -0.48, p = 0.01); Executive Functioning (Colors Trails 2, r (24) = -0.44, p = 0.02); Visuospatial (Rey Complex Figure Test [RCFT] Copy, r (24) = -0.47, p = 0.01 and Block Design, r (24) = -0.39, p = 0.04); Verbal Learning and Memory (WHO-AVLT Trial 5 - verbal learning, r (24) = -0.39, p = 0.05 and Trial 7 - short-delay verbal memory, r (24) = -0.38, p = 0.05).  

ANOVA results were significant on the Raven’s, F (2, 23) = 8.4, p = 0.001), with G1 (M = 0.26, SD = 0.60) scores significantly higher than both G2 (M = -1.02, SD = 0.95) and G3 (M = -1.00, SD = 0.47). WHO-AVLT Trial 5, was significant, F, (2, 23) = 4.39, p = 0.002), with G1 (M = 0.17, SD = 0.51) scores significantly higher than G3 (M = -1.06, SD = 0.87), and trending higher than G2 (M = -0.82, SD = 1.10). WHO-AVLT Trial 7 was significant, F (2, 23) = 4.35, p = 0.02), with G1 (M = -0.06, SD = 1.43) higher than G2 (M = -1.59, SD = 1.08) and G3 (M = -1.56, SD = 1.12). ANOVA results for remaining subtests revealed similar, trending results (i.e., p < 0.1) on select measures of delayed memory, language, attention, processing speed, visuospatial and motor dexterity.

Conclusions: Longer DD of TLE negatively impacts performance in multiple cognitive domains in a unique, Spanish-speaking, primarily immigrant cohort living in the U.S. This relationship has not been well studied in this population. Results were consistent with previous research that was largely done with English-speaking cohorts of the majority population. Significant and trending patterns suggested that DD of < 20 years was associated with statistically better performance than groups with DDs > 21 years. Declines of intelligence, verbal learning and short-term memory recall reduced to clinically impaired levels. Processing speed, executive functioning and visuospatial scores also declined with longer DD; however, these domains were relatively spared, or clinically intact (i.e., > 9^th percentile). This study was limited by a small sample. Larger, prospective studies are encouraged to rule out a critical DD of TLE that negatively impacts neuropsychological functioning after 20 years and to characterize functional limitations associated with DD in this population.

Funding: Please list any funding that was received in support of this abstract.: None.