Minneapolis

According to new research, people with epilepsy who live in disadvantaged neighbourhoods with higher poverty rates and fewer educational and employment opportunities may be more likely to have memory, thinking, and mental health problems than people with epilepsy who live in less disadvantaged neighbourhoods.

Findings of the study published in the online issue of Neurology, the medical journal of the American Academy of Neurology. The study does not prove that living in low-income areas causes memory and mental health issues. It only demonstrates a connection. "Epilepsy research has arguably ignored the potential impact of the social determinants of health in neighbourhoods on cognition--factors that have been hiding in plain sight for many years," said study author Robyn Busch, PhD, of Cleveland Clinic in Ohio.

"Our study shows that these neighbourhood social factors are linked to epilepsy outcomes." For the study, researchers reviewed a registry of people with temporal lobe epilepsy, the most common adult form of epilepsy associated with a high risk for thinking problems and depressed mood. Researchers identified 800 people with an average age of 38 whose epilepsy was resistant to treatment and who were evaluated for potential epilepsy surgery.

Researchers compared the participants' scores on measures of intelligence, attention, memory and other thinking skills, depression and anxiety. Researchers used the home address of each participant and a measure called the Area Deprivation Index to determine if each participant lived in an advantaged or disadvantaged neighbourhood. The index incorporates information on the socioeconomic conditions of each neighbourhood and its residents, ranking neighbourhoods based on 17 indicators including income, employment, education and housing quality.

Neighbourhoods in the index are determined by census areas of about 1,500 residents. Researchers divided participants into five groups based on neighbourhood advantage. In a composite score of all attention tests, with scores ranging from 60 to 135, people in neighbourhoods with the most disadvantage had an average score of 85 compared to those in neighbourhoods with the least disadvantage who had an average score of 95. Higher scores indicate better attention. Similar results were seen on measures of intelligence, processing speed, language, visuospatial skills, and memory.

People in the most disadvantaged neighbourhoods showed lower test scores than those in less disadvantaged neighbourhoods. Compared to people in neighbourhoods with the least disadvantage, people with the most disadvantage were more likely to have worse cognitive outcomes across tests of different thinking skills. People who self-identified as Black, Hispanic or from other non-white groups were overrepresented in the most disadvantaged neighbourhood group and were nearly three times more likely to have reduced scores on multiple cognitive tests than non-Hispanic white people.

Based on their self-reported symptoms, people in neighbourhoods with the most disadvantage reported mild symptoms of depression and anxiety compared to those in neighbourhoods with the least disadvantage who reported minimal symptoms of depression and anxiety. "These study findings elevate the need to consider the role of social and neighbourhood issues in assessing the outcomes for people with epilepsy," said editorial author Lidia M. V. R. Moura, MD, MPH, PhD of Massachusetts General Hospital in Boston and Fellow of the American Academy of Neurology.

"More research is needed to identify these social factors that may be modifiable that can help improve cognition and prevent further worsening. More community-based partnerships and the usage of screening and mapping tools may help reduce these disparities among people with epilepsy."