Factors associated with cognitive impairment among adults with epilepsy: A cross-sectional study of clinical and electroencephalographic findings in Indonesia

Abstract

The contributions of age at epilepsy onset, seizure burden, and electroencephalographic abnormalities to cognitive dysfunction remain incompletely understood, particularly among adults with epilepsy in resource-limited settings. The aim of this study was to evaluate the associations of age at epilepsy onset, seizure frequency, and electroencephalographic (EEG) findings with cognitive function in patients with epilepsy. A cross-sectional study was conducted among patients with epilepsy attending the Neurology Outpatient Clinic of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, between November 2025 and January 2026. Cognitive function was assessed using the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina), with scores <26 indicating cognitive impairment. Age at epilepsy onset, seizure frequency during the preceding 12 months, EEG findings, comorbidity status, and antiseizure medication regimen were obtained from medical records and structured interviews. Cognitive impairment was identified in 65.7% of patients, with a median MoCA-Ina score of 24 (range, 3–30). Patients with epilepsy onset at <10 or ≥40 years had a higher proportion of cognitive impairment than those with onset at 10–39 years (p=0.003); however, the logistic regression model failed to converge because of complete separation, precluding a valid odds-ratio (OR) estimate. Seizure frequency was not significantly associated with cognitive function (OR=0.991; p=0.306). In contrast, abnormal EEG findings were associated with lower odds of normal cognitive function (OR=0.260; p=0.031), while patients without comorbidities had higher odds of normal cognitive function than those with comorbidities (OR=5.40; p=0.004). Antiseizure medication regimen was not significantly associated with cognitive function (OR=1.53; p=0.405). Cognitive impairment was common among adults with epilepsy and was significantly associated with abnormal EEG findings and comorbidity status, while seizure frequency and antiseizure medication regimen were not significantly associated with cognitive function.