For years, epilepsy and dementia were considered distinct neurological conditions, each with its own causes, symptoms, and treatment approaches. However, research has shown that the two can influence one another in complex ways. While epilepsy can increase the risk of developing dementia, dementia can also raise susceptibility to seizures. Recognizing this connection is essential for early diagnosis and improved treatment strategies. This blog series explores the significant—but often overlooked—overlap between epilepsy and dementia, particularly in older adults. 

How Are Epilepsy and Dementia Connected? 

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures caused by abnormal electrical activity in the brain (Epilepsy Foundation, n.d.). Dementia, by contrast, refers to a group of disorders that cause progressive cognitive decline, with Alzheimer’s disease and vascular dementia being the most common types (Ghosh et al., 2021). While the conditions are clinically distinct, mounting research suggests a strong link between seizure activity and cognitive impairment. 

A particularly important connection is the presence of focal onset impaired awareness seizures—a type of non-convulsive seizure that often affects older adults. These seizures, which involve brief periods of confusion, memory lapses, or altered awareness, are sometimes mischaracterized by patients as “absence seizures,” though they are clinically different. Unlike generalized onset nonmotor (true absence) seizures, which typically begin in childhood and are not usually associated with long-term cognitive decline, focal seizures in older adults are longer in duration and strongly associated with dementia risk. 

Because these focal seizures can appear subtle—causing unresponsiveness, confusion, or short-term amnesia—they are often mistaken for symptoms of early dementia. This overlap can lead to misdiagnoses and delays in treatment (Nadkarni & Devinsky, 2005). 

The relationship is bidirectional. While epilepsy can contribute to long-term cognitive decline due to repeated episodes of neuroinflammation, oxidative stress, and neuronal damage, dementia-related changes—such as amyloid and tau accumulation in Alzheimer’s or vascular damage in stroke-related dementia—can also lower the brain’s threshold for seizure activity (Zhang et al., 2022). In either case, the two conditions can exacerbate one another, worsening overall brain function. 

Who Is at Risk? 

Older adults are particularly vulnerable to the overlap between epilepsy and dementia. Approximately one million Americans over the age of 55 have epilepsy, and the prevalence of dementia rises sharply with age (Epilepsy Foundation, n.d.). Studies show that individuals with late-onset epilepsy—meaning seizures that begin after age 60—have an increased likelihood of also developing Alzheimer’s disease or vascular dementia (Sen et al., 2018). 

However, many of these cases go undiagnosed or misdiagnosed. Focal seizures may present as brief episodes of confusion, word-finding difficulty, or memory loss—symptoms often attributed to normal aging or early dementia. Because these seizures usually do not involve convulsions, they can easily be overlooked, delaying appropriate treatment that could improve cognition and quality of life (Ghosh et al., 2021). 

Key Symptoms to Watch For 

Recognizing the signs of seizure activity in older adults can help differentiate epilepsy from dementia. Symptoms that may suggest seizure activity rather than progressive cognitive decline include: 

• Sudden episodes of confusion or staring spells lasting seconds to minutes 

• Brief memory lapses or difficulty recalling words that come and go 

• Unexplained falls or jerking movements that are not typical for dementia 

• Periods of unresponsiveness followed by confusion 

• Visual hallucinations or distortions (sometimes mistaken for psychiatric symptoms) 

If you or a loved one exhibits these symptoms, it’s important to consult a neurologist. Electroencephalography (EEG) testing can help detect abnormal brain activity consistent with seizures. 

Why This Matters: Improving Diagnosis and Treatment 

Understanding the bidirectional relationship between epilepsy and dementia is essential for improving outcomes. Misdiagnosis could mean that a patient with epilepsy receives no seizure management, or that a person with dementia is experiencing untreated seizure-related cognitive fluctuations. Early identification allows for better-targeted treatment—and often, better quality of life. 

If you or someone you care about is showing signs of cognitive decline, don’t assume it’s just aging. Consider whether seizures might be playing a role and seek a neurological evaluation. 

For more information about epilepsy and dementia, or to learn about seizure recognition and first aid, please contact the Epilepsy Foundation of Northeastern New York at (518) 456-7501 or visit our website. 

References 

• Epilepsy Foundation. (n.d.). What is epilepsy? https://www.epilepsy.com/what-is-epilepsy 

• Ghosh, S., et al. (2021). Pharmacological and therapeutic approaches in the treatment of epilepsy. Biomedicines. 

• Nadkarni, S., & Devinsky, O. (2005). Psychotropic effects of antiepileptic drugs. Epilepsy Currents. 

• Sen, A., et al. (2018). Cognition and dementia in older patients with epilepsy. Brain: A Journal of Neurology. 

• Zhang, D., et al. (2022). The clinical correlation between Alzheimer’s disease and epilepsy. Frontiers in Neurology.