Browsing by Author "McMillan, Jacqueline M."

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    Risk Factors for Dementia Development, Frailty, and Mortality in Older Adults with Epilepsy: A Population-Based Analysis
    (2020-08-28) Subota, Ann Ana; Holroyd-Leduc, Jayna M.; Jetté, Nathalie J.; Josephson, Colin Bruce; McMillan, Jacqueline M.
    As the global population ages, more individuals will develop and live with epilepsy and dementia. Previous literature suggests older adults with epilepsy are more likely to develop dementia, yet little is understood about the impact of dementia and frailty in older adults with epilepsy. This thesis aimed to address these knowledge gaps by examining the risk factors for incident dementia development and the role of dementia and frailty on mortality in older adults with incident epilepsy. A cohort of 1048 older adults with incident epilepsy aged 65 years or older were identified using a large population-based primary care dataset from the United Kingdom. The odds of having dementia were 7.39 [95% CI 5.21-10.50] times higher in older adults with incident epilepsy compared to older adults without epilepsy (p-value < 0.001). In the final multivariable logistic model, only the Charlson comorbidity index score at baseline incident epilepsy diagnosis was significantly associated with an increased odds of incident dementia [OR: 1.34, 95% CI 1.14-1.56, p-value < 0.001]. In a multivariate Cox model, age [HR: 1.06, 95% CI 1.02-1.11, p-value < 0.002], baseline dementia [HR: 2.68, 95% CI 1.66-4.33, p-value < 0.001] and baseline e-frailty index score [HR: 7.64, 95% CI 1.21-48.19, p-value = 0.030] were significantly associated with a higher hazard of death among older adults with incident epilepsy. The presence of dementia and the degree of frailty experienced both significantly increase the hazard of death in older adults with incident epilepsy. e-Frailty index scores could be utilized more widely in epilepsy clinics in all older adults with epilepsy to identify individuals who may be at greater risk of dying; additional supports and interventions could be provided to reduce mortality in older adults with epilepsy.