Epilepsy and dementia in the elderly:its bidirectional association

Riki Matsumoto

Division of Neurology, Kobe University Graduate School of Medicine

Epilepsy is one of the common neurological diseases that will further increase in the super-ageing society.　Most of late-onset epilepsy belongs to focal epilepsy with temporal lobe epilepsy being most frequent.　The major etiology includes cerebrovascular diseases and dementia.　Recent long-standing prospective cohort studies implicated the bidirectional association between the elderly-onset epilepsy and dementia.　Furthermore, several lines of evidence indicate Alzheimer pathology as the underlying pathophysiology of late-onset unexplained epilepsy （LOUE）.　Silent spikes （in the absence of clinical seizures） indeed can occur in the early stage of Alzheimer’s disease, probably reflecting the neuronal hyperexcitability of the medial temporal structures.　It is now known that not only the neurodegeneration but also the vascular risk factors such as hypertention, diabetes and smoking increase the risk of developing epilepsy as is the case with Alzheimer’s disease.　Multidisciplinary researches are warranted to untangle the interrelation between epilepsy, Alzheimer’s disease and cerebrovascular disease for better understanding of shared mechanisms and treatment.

Address correspondence to Riki Matsumoto MD, PhD, Division of Neurology, Kobe University Graduate School of Medicine（7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan）