People with epilepsy who have anxiety or depression are more likely to experience memory problems that impair social function, a study has shown.
Anxiety was also associated with memory complaints linked to executive function, while patients with mood disturbances more often reported issues related to core aspects of their life, such as forgetting biographical details or not recognising close relatives.
“Clinicians should be alert to these signature subjective memory complaints reported in neurology clinics as they may be more indicative of anxiety and/or depression rather than a fundamental impairment in underlying memory processes,” wrote the authors, including Professor Sallie Baxendale, a consultant neuropsychologist at University College London Hospital.
They also suggested that “careful attention to the nature of patients’ complaints may inform optimal treatment approaches”.
The study, published in Epilepsia Open [link here], analysed responses to the Hospital Anxiety and Depression Scale (HADS) and Subjective Memory Questionnaire (SMQ) from 375 epilepsy patients (mean age 37 years, 53% female) assessed in 2023 at the National Hospital for Neurology & Neurosurgery and the UCLH Chalfont Centre for Epilepsy.
The data showed that patients with moderate or severe levels of anxiety and depression had a significantly higher overall burden of memory complaints, compared to those with normal-to-mild scores.
Further analysis revealed that the reported memory complaints could be divided into three factors, which the researchers termed “Social”, “Losses” and “Executive”.
Social complaints involved verbal memory issues in social situations, such as forgetting names or recent information, repeating oneself or rambling, or struggling to follow a conversation.
The second factor referred to “losses from the core store of memories”, which manifested in the inability to recognise relatives or places, getting lost, and/or forgetting key details about oneself.
Executive complaints encompassed aspects of memory that impacted attention and organisation, for example forgetting where things are or failing to remember changes in routine.
Patients with moderate or severe anxiety (29% of the study group) were significantly more likely to report Social and Executive memory complaints, compared to those with low-mild anxiety.
Meanwhile, patients with moderate or severe levels of depression (11%) were significantly more likely to exhibit issues related to the Social and Losses factors, compared to subjects with low-mild depression scores.
“Clinicians may consider probing more deeply about the nature of memory difficulties when they are raised in the clinic, either via semi-structured interview questions or by using a validated measure of subjective memory complaints,” the authors suggested.
They also noted several limitations to their work; primarily their use of subjective memory complaints and a simple screening scale (HADS), rather than measures of cognitive function and psychiatric evaluation.
Participants had also been referred for neuropsychological evaluation and so may have had more severe epilepsy or be on higher medication doses, meaning the results may not be generalisable to a broader patient population.
However, while the heterogeneity of the study group makes it possible the results could be explained by clinical and demographic variables not captured by the authors, “it does accurately reflect the caseload of referrals to a neuropsychology department, and, as such, provides useful data to help guide clinical practice,” they stressed.