Cognitive impairment in older adults with epilepsy: a systematic review

Background With the increasing aging population, the number of older adults with epilepsy (OAE) is growing, a trend that warrants greater attention. The aim of this systematic review is to summarize the cognitive comorbidities in OAE and to identify the factors associated with cognitive impairment in this population. Methods We searched original research articles in three databases (PubMed, Web of Science, and EMBASE) between November 12 th , 2019, and November 12 th , 2025, on the cognitive performance of OAE and its related conditions. A total of 62 articles were included for the final analysis, strictly following the PRISMA guideline. Results Cross-sectional studies indicated that the median percentage of cognitive impairment in OAE was 51.6% (25.9∼87%). Memory (31.5% [29.3∼44.0%]), language (38% [15.0∼39.8%]), and executive (35.0% [25.0∼41.0%]) functions were also impaired. 14.0% (5.9∼49.9%) of OAE presented with dementia at the first diagnosis, and they were 2.5 times more likely to develop dementia than controls, which could contribute to premature death and other clinical outcomes. Factors including demographic features, seizure-related conditions, clinical comorbidities, antiseizure medications (ASMs), and surgery contributed to cognitive decline in OAE. Conclusions Cognitive impairment is common among OAE. Clinicians should pay more attention to this cognitive comorbidity in OAE and manage the related factors that may worsen the situation. Early identifications and targeted interventions may help delay cognitive deterioration, improve quality of life, and reduce healthcare burden.