The edition · Neurology
Epilepsy strongly associated with young-onset dementia in French and Swedish national data
A two-country analysis of epilepsy and dementia before 65, global dementia incidence from 22 cohorts, a lifestyle programme in multiple sclerosis, a consensus definition of controlled myasthenia, and a trial of earlier blood biomarker disclosure in a memory clinic.
The edition in brief
Nationwide French and Swedish analyses found epilepsy strongly associated with young-onset dementia, diagnosed before 65. In France, 12.5% of 11,360 cases had earlier epilepsy codes against 1.2% of controls (adjusted OR 3.76, 95% CI 3.42 to 4.14). In a French cohort of adults aged 30 to 55, 10-year cumulative incidence of young-onset dementia was 2.20% with new epilepsy against 0.21% without (adjusted HR 6.02, 95% CI 4.98 to 7.26). A meta-analysis of 22 cohorts (38,418 people, 18 countries) estimated standardised dementia incidence at 9.7 per 1,000 person-years, higher in women than men (10.6 vs 8.6) and in low- and middle-income countries (13.6) than high-income (8.3). A 24-month follow-up of a digital lifestyle programme in 659 people with multiple sclerosis found modest, mostly short-term gains in patient-reported outcomes, without a control group. A consensus definition of adequately controlled generalised myasthenia gravis, applied to 220 Spanish patients, found 17.7% never reached control. In a single-centre trial of 220 memory clinic patients, disclosing plasma p-tau217 and neurofilament light chain at 3 months rather than 9 raised very high-confidence diagnosis (50.0% vs 4.6%) without worsening emotional outcomes.
Epilepsy was strongly associated with dementia before age 65
Take cognitive complaints seriously in people with epilepsy under 65 and consider formal assessment, without assuming the epilepsy causes the dementia.
Global dementia incidence is higher in women and in lower-income countries
Plan memory services for a larger share of women and older patients in lower-income settings, using these rates as rough benchmarks.
A lifestyle programme in multiple sclerosis gave modest, mostly short-term gains
Offer diet, sleep and stress advice as an add-on in multiple sclerosis, with realistic expectations and no change to disease-modifying treatment.
Almost 1 in 5 patients with generalised myasthenia never reached consensus-defined control
Use a defined control target, such as MG-ADL of 2 or less with no recent exacerbations, to decide whether myasthenia treatment needs escalation.
Check the medication list before blaming myasthenia for a flare
When myasthenia flares, review drugs started in the past week before changing immunosuppression.
Earlier blood biomarker results sharpened memory clinic diagnoses without more distress
Where validated plasma p-tau217 assays are available, consider using them early in the memory clinic work-up, interpreted alongside clinical assessment.
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