Treatment of Epilepsy in the Setting of Cognitive Decline in Older Adults

Purpose of Review: Discuss the state of the literature for the treatment of comorbid epilepsy and cognitive dysfunction, specifically focusing on the older adult. Recent Findings: Epilepsy and cognitive dysfunction are neuronal network disorders with converging molecular underpinnings. Anti-seizure medication is not obligatory after the first instance of a seizure in the setting of cognitive dysfunction. In the absence of randomized controlled trials, current practice is largely based on individual clinical presentation and estimated risk of recurrence. Screening for epilepsy in the context of cognitive dysfunction and cognitive dysfunction in the context of epilepsy should occur early and often throughout treatment. Summary: Decreasing central nervous system polypharmacy is highly recommended in elderly patients, and early cognitive/epilepsy screening may improve both treatment and clinical outcomes. Neuromodulatory techniques and diet modifications are promising treatments that would benefit from additional research. Overall, elucidating the pathological mechanisms that connect epilepsy and cognitive impairment in this population could help direct future treatments.