{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T15:08:57Z","timestamp":1788793737812,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["R01NS120976"],"award-info":[{"award-number":["R01NS120976"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Instrumental activities of daily living (IADLs) represent a critical but understudied measure of day\u2010to\u2010day function in people with epilepsy (PWE). In the multicenter Brain Aging and Cognition in Epilepsy (BrACE) study of PWE \u226555\u2009years of age, we examined the proportion, clinical correlates, epilepsy\u2010related predictors, and longitudinal trajectory of IADL impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>IADLs were assessed using the Functional Activities Questionnaire (FAQ; range\u2009=\u20090\u201330; higher\u2009=\u2009more impaired); FAQ\u2009\u2265 2 defines mild cognitive impairment (MCI)\u2013level impairment and FAQ\u2009\u2265 5 dementia\u2010level functional impairment. Multivariable Firth penalized logistic regression identified factors associated with baseline functional impairment. Global cognition (Montreal Cognitive Assessment [MoCA]), individual cognitive measures, and quality of life (QOL) were compared between the impaired and unimpaired groups. Exploratory linear regression evaluated factors associated with longitudinal functional decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 57 participants (mean age \u00b1 SD\u2009=\u200966.6\u2009\u00b1\u20097.2\u2009years; female\u2009=\u200952.6%), 38.6% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200922) had MCI\u2010level functional impairment and 17.5% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910) had dementia\u2010level functional impairment. In univariate analyses, worse FAQ scores were associated with lower education, higher area\u2010deprivation index, early\u2010onset epilepsy (EOE;\u2009&lt;60\u2009years), anti\u2010seizure medication polytherapy, and epilepsy localization (all\n                      <jats:italic>p<\/jats:italic>\n                      's\u2009&lt;\u2009.05). In multivariable analysis, temporal lobe epilepsy (odds ratio [OR]\u2009=\u20093.73, 95% confidence interval [CI]\u2009=\u20091.02\u201316.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.047), EOE (OR\u2009=\u20096.91, 95% CI\u2009=\u20091.36\u201346.37,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.019), and lower education (OR\u2009=\u20090.69, 95% CI\u2009=\u20090.51\u20130.90,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.004) remained independently associated with baseline MCI\u2010level functional impairment. Lower education (OR\u2009=\u20090.62, 95% CI\u2009=\u20090.37\u20130.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.004) was the only factor associated with dementia\u2010level IADL impairment. IADL\u2010impaired participants demonstrated lower verbal memory scores (adjusted\u2010\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.042) and MoCA (adjusted\u2010\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.006), particularly in visuospatial\/executive function, attention, and memory subscores, and worse QOL (adjusted\u2010\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.042). IADL impairment was greatest in financially\u2010mediated and memory\u2010dependent tasks. Longitudinally, EOE (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.017) and older age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.012) were associated with greater functional decline. Four of 13 participants (approximately one\u2010third) progressed to significantly worse function over a 2\u2010year period, with two (15.4%) progressing from MCI\u2010level to dementia\u2010level impairment and two (15.4%) from normal function to MCI\u2010level IADL impairment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>Functional impairment affects ~40% of older PWE, with ~1\u2010in\u20106 experiencing functional impairment comparable to overt dementias. Temporal lobe localization, EOE, lower education, and poorer cognition are important determinants of baseline functional status. Exploratory longitudinal analyses has suggested that EOE and older age were associated with accelerated functional decline, although these findings require confirmation in larger cohorts. These findings provide one of the first epilepsy\u2010specific characterizations of IADL impairment and support routine functional assessment in PWE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70478","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:20:41Z","timestamp":1788790841000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Instrumental activities of daily living in older adults with epilepsy: A cross\u2010sectional and longitudinal multicenter study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6103-4250","authenticated-orcid":false,"given":"Ifrah","family":"Zawar","sequence":"first","affiliation":[{"name":"Department of Neurology University of Virginia School of Medicine  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anny","family":"Reyes","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Helm","sequence":"additional","affiliation":[{"name":"Department of Psychology San Diego State University  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayela","family":"Arrotta","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce P.","family":"Hermann","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alena","family":"Stasenko","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn M.","family":"Busch","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Quigg","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Virginia School of Medicine  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaideep","family":"Kapur","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Virginia School of Medicine  Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron F.","family":"Struck","sequence":"additional","affiliation":[{"name":"Department of Neurology Washington University School of Medicine in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Punia","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"McKenna E.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Neurosciences University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine J.","family":"Bangen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Wang","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry J.","family":"Shih","sequence":"additional","affiliation":[{"name":"Department of Neurology University of California San Diego  La Jolla California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Epilepsy Center, Neurological Institute Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana E.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Wisconsin School of Medicine and Public Health  Madison Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carrie 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