title: Mechanisms of memory impairment in epilepsy depend on age at disease onset.
abstract: OBJECTIVE
  In this study, we aimed to uncover distinct antecedents of autobiographic memory dysfunction in patients with epilepsy with early (childhood/adolescence) vs late (adulthood) disease onset.
  
  
  METHODS
  One hundred sixty-six adults participated: 92 patients with focal epilepsy, whose cognitive and psychiatric functioning were compared to that of 74 healthy controls. Predictors of autobiographic memory deficit were contrasted between patients with early-onset (n = 47) vs late-onset (n = 45) epilepsy.
  
  
  RESULTS
  Overall, people with epilepsy performed significantly worse on measures of both semantic and episodic autobiographic memory and showed markedly high rates of depressive symptoms and disorders (p < 0.001). Reduced autobiographic memory in patients with early-onset epilepsy was associated with young age at onset, more frequent seizures, and reduced working memory. In contrast, the difficulty that patients with late-onset epilepsy had in recalling autobiographic information was linked to depression and the presence of an MRI-identified lesion.
  
  
  CONCLUSIONS
  This study reveals that memory deficits in people with focal epilepsy have differing antecedents depending on the timing of the disease onset. While neurobiological factors strongly underpin reduced autobiographic function in patients with early-onset epilepsy, psychological maladjustment gives rise to the impairments seen in patients with late-onset epilepsy. More broadly, these findings support the practice of subtyping patients according to distinct clinical characteristics to find individualized predictors of cognitive dysfunction.
authors.affiliation: From the Melbourne School of Psychological Sciences (G.R., S.J.W.), The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (G.R., G.D.J., S.J.W.), Brain Research Institute, The University of Melbourne, Heidelberg; and Comprehensive Epilepsy Programme (G.D.J., S.J.W.), Austin Health, Melbourne Brain Centre, Heidelberg, Australia. raynerg@unimelb.edu.au.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Rayner
authors.affiliation: From the Melbourne School of Psychological Sciences (G.R., S.J.W.), The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (G.R., G.D.J., S.J.W.), Brain Research Institute, The University of Melbourne, Heidelberg; and Comprehensive Epilepsy Programme (G.D.J., S.J.W.), Austin Health, Melbourne Brain Centre, Heidelberg, Australia.
authors.forename: Graeme D
authors.initials: GD
authors.lastname: Jackson
authors.affiliation: From the Melbourne School of Psychological Sciences (G.R., S.J.W.), The University of Melbourne; The Florey Institute of Neuroscience and Mental Health (G.R., G.D.J., S.J.W.), Brain Research Institute, The University of Melbourne, Heidelberg; and Comprehensive Epilepsy Programme (G.D.J., S.J.W.), Austin Health, Melbourne Brain Centre, Heidelberg, Australia.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Wilson
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D004828:Epilepsies, Partial / Q000150:complications* / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000209:etiology* / Q000503:physiopathology; D061212:Memory, Episodic; D008570:Memory, Short-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012640:Seizures / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D012660:Semantics; D055815:Young Adult