Neuropsychological function in psychosis of epilepsy

James Allebone; Richard A Kanaan; Genevieve Rayner; Jerome Maller; Terence J O'Brien; Saul A Mullen; Mark Cook; Sophia J Adams; Simon Vogrin; David N Vaughan; Patrick Kwan; Samuel F Berkovic; Wendyl J D'Souza; Graeme Jackson; Dennis Velakoulis; Sarah J Wilson

doi:10.1016/j.eplepsyres.2023.107222

Neuropsychological function in psychosis of epilepsy

Epilepsy Res. 2023 Oct:196:107222. doi: 10.1016/j.eplepsyres.2023.107222. Epub 2023 Sep 15.

Authors

James Allebone¹, Richard A Kanaan², Genevieve Rayner³, Jerome Maller⁴, Terence J O'Brien⁵, Saul A Mullen⁶, Mark Cook⁷, Sophia J Adams⁸, Simon Vogrin⁹, David N Vaughan¹⁰, Patrick Kwan⁵, Samuel F Berkovic¹¹, Wendyl J D'Souza¹², Graeme Jackson¹⁰, Dennis Velakoulis¹³, Sarah J Wilson³

Affiliations

¹ Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
² The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Psychiatry, University of Melbourne, Austin Health, Melbourne, Australia. Electronic address: richard.kanaan@unimelb.edu.au.
³ Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
⁴ ANU College of Health and Medicine, Australian National University, Canberra, Victoria, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
⁵ Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Neuroscience, Alfred Hospital, Monash University, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
⁶ The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
⁷ Graeme Clark Institute, University of Melbourne, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
⁸ Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
⁹ St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
¹⁰ The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
¹¹ Comprehensive Epilepsy Program, Austin Health, University of Melbourne, Victoria, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
¹² Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.
¹³ Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne, Health, Melbourne, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Victoria, Australia.

PMID: 37717505
DOI: 10.1016/j.eplepsyres.2023.107222

Abstract

Objective: The neuropsychological profile of patients with psychosis of epilepsy (POE) has received limited research attention. Recent neuroimaging work in POE has identified structural network pathology in the default mode network and the cognitive control network. This study examined the neuropsychological profile of POE focusing on cognitive domains subserved by these networks.

Methods: Twelve consecutive patients with a diagnosis of POE were prospectively recruited from the Comprehensive Epilepsy Programmes at The Royal Melbourne, Austin and St Vincent's Hospitals, Melbourne, Australia between January 2015 and February 2017. They were compared to 12 matched patients with epilepsy but no psychosis and 42 healthy controls on standardised neuropsychological tests of memory and executive functioning in a case-control design.

Results: Mean scores across all cognitive tasks showed a graded pattern of impairment, with the POE group showing the poorest performance, followed by the epilepsy without psychosis and the healthy control groups. This was associated with significant group-level differences on measures of working memory (p = < 0.01); immediate (p = < 0.01) and delayed verbal recall (p = < 0.01); visual memory (p < 0.001); and verbal fluency (p = 0.02). In particular, patients with POE performed significantly worse than the healthy control group on measures of both cognitive control (p = .005) and memory (p < .001), whereas the epilepsy without psychosis group showed only memory difficulties (delayed verbal recall) compared to healthy controls (p = .001).

Conclusion: People with POE show reduced performance in neuropsychological functions supported by the default mode and cognitive control networks, when compared to both healthy participants and people with epilepsy without psychosis.

Keywords: Interictal psychosis; Memory, epilepsy; Postictal psychosis; Psychosis.

MeSH terms

Epilepsy* / complications
Executive Function
Health Status
Healthy Volunteers
Humans
Memory, Short-Term