Dementia encompasses a range of progressive conditions that affect cognitive function, impacting memory, thinking, and behavior. Understanding the various manifestations and complications associated with dementia becomes increasingly important. The connection between dementia and seizures, though recognized in medical science, often remains less understood by the general public.
The Link Between Dementia and Seizures
Seizures can occur in individuals living with dementia, representing a recognized neurological complication. People with dementia, particularly those with Alzheimer’s disease, face an increased risk of experiencing seizures compared to the general population. This risk can be substantial, with individuals being six to ten times more likely to develop seizures.
While seizures were once thought to primarily manifest in the later stages of dementia due to extensive brain changes, more recent research suggests they can also emerge earlier in the disease course, sometimes even before memory problems become apparent. In some instances, seizures may even be among the first indications of certain types of dementia.
Underlying Causes of Seizures in Dementia
The occurrence of seizures in dementia stems from profound brain changes. Damage to brain cells and subsequent brain shrinkage can disrupt normal electrical activity, leading to seizures. This disruption arises from an imbalance between excitatory and inhibitory signals in the brain’s neural networks, causing cells to become “hyperexcitable” and fire uncontrollably.
Specific pathologies associated with different types of dementia contribute to increased seizure susceptibility. In Alzheimer’s disease, abnormal proteins like amyloid plaques and neurofibrillary tangles interfere with nerve cell communication. Cerebrovascular events, such as strokes common in vascular dementia, can also cause brain damage that predisposes individuals to seizures. Neuronal loss, particularly of inhibitory neurons, can further disrupt brain activity.
Recognizing Seizure Manifestations
Identifying seizures in individuals with dementia can be challenging, as their manifestations may differ from the dramatic, full-body convulsions often depicted in media. Many seizures are focal onset, originating in a specific brain area. These can be subtle and mistaken for typical dementia behaviors like confusion or agitation.
Common presentations of focal onset seizures include brief periods of unresponsiveness or staring spells. Repetitive movements, known as automatisms, are frequent, involving involuntary actions of the hands, arms, or facial movements like chewing or lip-smacking. Other subtle signs include sudden shifts in mood, unusual sensations like déjà vu, or subtle motor twitches. Due to their atypical nature, these “silent seizures” can easily go unnoticed or be attributed to cognitive decline.
Managing Seizures in Individuals with Dementia
When seizures are suspected in someone with dementia, a medical evaluation is important. This involves diagnostic tests to confirm seizure activity and rule out other causes. An electroencephalogram (EEG), which measures brain activity, is a primary tool. Magnetic Resonance Imaging (MRI) may also be used to visualize brain structures and identify underlying causes.
Treatment often involves anti-seizure medications. Careful selection is necessary due to potential interactions with other drugs and possible side effects in older adults with dementia. Newer anti-seizure medications are generally preferred due to their more favorable side effect profiles and reduced likelihood of interfering with other medications. Safety measures might also be recommended to minimize injury during a seizure.