We have collaborated with PI Hyunmi Choi, MD, at Columbia University in New York, for the study entitled “Effects of Vascular Risk Factors on Risk for Dementia and Stroke After Late-Onset Epilepsy (EPILEPSY COG).” U-M is a subcontract and Deb Levine is the U-M site PI. At U-M, Emily Briceño is a co-I on the study alongside her Consultant Christopher Gonzalez and U-M Site Project Manager Adam Kollipara, MPH.
Immediate objectives are to rigorously investigate relationships of late-onset epilepsy (LOE) and pre-epilepsy vascular risk factors (VRFs) with cognitive decline and characterize potential biological mechanisms, develop risk prediction algorithms for ADRD and stroke/cardiovascular disease (CVD) that accurately estimate risk in the setting of LOE, and integrate LOE into a microsimulation modeling paradigm for testing the effects of VRF interventions in clinical trials. To accomplish these objectives, six existing NIH-funded US-based cardiovascular cohort studies will be pooled and epilepsy ascertainment will be added to these cohorts. Harmonized measures of VRFs and longitudinal trajectories of global cognitive ability, executive function, and memory in five of these cohorts (ARIC, CHS, MESA, NOMAS, REGARDS) have been created. An additional cohort (WHICAP) will be integrated to increase racial/ethnic diversity and improve generalizability. Comprising over 69,000 older adults with cognitive data harmonization and 1,600 LOE cases, this innovative resource will be unprecedented in epilepsy research, directly addressing the absence of a large-scale study of consequences of LOE, an unfulfilled priority of the 2012 Institute of Medicine report on epilepsy.
It is expected that this study will propel clinical care models for LOE to include accurate vascular risk assessment and treatment. Long-term objectives are to increase awareness of LOE as a vascular risk marker, incorporate LOE into prevention guidelines, and disseminate prevention strategies to slow ADRD and reduce stroke and CVD risk in individuals with LOE.