Abstracts

Rationale: Memory complaints are common among patients with epilepsy. The A-B Neuropsychological Assessment Schedule (ABNAS) is a patient-reported scale validated to measure adverse cognitive effects of antiepileptic drugs (AEDs). The goals of this study were to identify predictors of patient-reported cognitive dysfunction and to assess the relationship between subjective and objective cognitive impairment. Methods: This IRB-approved study made use of the Cleveland Clinic Knowledge Program Data Registry to identify adult patients who presented to the outpatient epilepsy clinic from January to March 2015 and completed the following scales: ABNAS for subjective cognitive impairment, Patient Health Questionnaire (PHQ-9) for depression, Generalized Anxiety Disorder 7-item Scale (GAD-7) for anxiety, Quality of Life in Epilepsy (QOLIE-10) and EuroQOL five dimensions questionnaire (EQ-5D) for health-related quality of life (n=670). Topiramate (TPM) was considered a high risk medication for cognitive impairment. Patients were categorized into groups based on total ABNAS score: subjective cognitive impairment (ABNAS>15, n=270) and minimal subjective complaints (ABNAS < 15; n=400). Binary logistic regression assessed the ability of the following factors to predict subjective cognitive impairment: age, gender, race, marital status, PHQ-9, GAD-7, QOLIE-10, EQ-5D, number of AEDs, use of TPM, and seizure frequency. In a subset of patients who had neuropsychological testing within 6 months of completing the ABNAS (n=60), Pearson correlations and ANCOVAs (controlling for depression and anxiety) assessed the relationship between subjective cognitive impairment and objective cognitive performance on measures of intelligence, attention/working memory, verbal fluency, naming, processing speed, manual dexterity, visuomotor sequencing, and verbal memory. Results: Forty percent of patients reported subjective cognitive impairment. Among the entire sample, median scores were as follows: ABNAS=11, PHQ-9=5, EQ-5D=0.83, QOLIE-10=20, and GAD-7=3. Seven percent of patients were not prescribed AEDs, 77% 1-2 AEDs, 16% more than 2 AEDs. 10% were taking TPM. Number of AEDs, PHQ-9, and QOLIE-10 were correlated with patient-reported cognitive impairment (p < 0.001). In the subset of patients with neuropsychological testing, ABNAS score was correlated with anxiety (r=0.44), depression (r=0.38), and attention/working memory (r= -0.31). After correcting for depression and anxiety via ANCOVA, patients who endorsed subjective cognitive impairment showed lower scores on measures of nonverbal intelligence and attention/working memory, but not on other cognitive measures. Conclusions: High ABNAS score was related to number of AEDs, but not to use of TPM. Interestingly, ABNAS score was also strongly related to affective state and QOL, but did not show strong relationships with most objective cognitive measures, similar to other subjective cognitive questionnaires in the literature. Funding: None