title: Incidence and risk of seizures in Alzheimer's disease: A nationwide population-based cohort study.
abstract: The reported incidence and risk factors mediating seizures in Alzheimer's disease (AD) have been extremely inconsistent and relevant data is lacking in Asia. We investigated the incidence rate and risk of seizures in AD and in a large, nationwide cohort from Han Chinese. A retrospective population-based study was conducted on the data from Taiwan's National Health Insurance Research Database from 2000 to 2010. To reduce selection bias, we applied propensity scores, wherein 981 patients with AD were matched to 3835 non-AD controls from a pool of 1000,000 randomly sampled cohort dataset. This approach was based on age, sex, comorbidities and previous brain conditions. Incidence rate, cumulative incidence and hazard ratios (HRs) were estimated. During the 10-year follow-up period (mean follow-up time, 4.02 years), 44 out of 937 AD patients (4.7%) developed seizures. The incidence rate in the AD cohort (11.9 per 1000 person-years) was higher than that in the matched cohort (5.7 per 1000 person-years), with an adjusted HR of 1.85 (95% confidence interval [CI], 1.20-2.83, p=0.005). The mean duration from the diagnosis of AD to the occurrence of seizure is 3.6 years. The Cox regression analysis revealed that AD itself is a significant predictor after adjustment for confounders (HR=2.01, 95% CI, 1.40-2.90, p<0.001). Moreover, age is an independent predictor, with an adjusted HR of 1.03 (95% CI, 1.00-1.05, p=0.019). In conclusion, seizure occurrence in AD is more common than in the matched cohort. Notably, advanced age carries a higher risk for development of seizures in patients with AD.
authors.affiliation: Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chia-Hsiung
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Internal Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, National Yang-Ming University, Taipei, Taiwan; Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Laboratory of Neurophysiology, Taipei Veterans General Hospital, Taipei, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: yylin@vghtpe.gov.tw.
authors.forename: Yung-Yang
authors.initials: YY
authors.lastname: Lin
authors.affiliation: Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Neurology, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taipei, Taiwan; Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: sjwang@vghtpe.gov.tw.
authors.forename: Shuu-Jiun
authors.initials: SJ
authors.lastname: Wang
mesh_terms: D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000503:physiopathology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology* / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology
keywords: Alzheimer's disease; Asia; Incidence; Seizures