# Seizure, cognitive change and dementia: Understanding the use and safety of anti-seizure medications

> **NIH NIH K23** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $165,605

## Abstract

PROJECT SUMMARY
 Guidelines for anti-seizure medications in older adult populations are incomplete or non-existent, even
though the risk of recurrent unprovoked seizures (epilepsy) in adults peaks at 80 years old. As a group, anti-
seizure medications are generally thought to be equally efficacious and medication choice should be informed
by the secondary effects of these drugs. Older adults are likely to be particularly vulnerable to cognitive adverse
effects because they may have lower cognitive reserve, undetected/undiagnosed neurodegeneration, competing
cognitive impairing disorders, and often take other CNS-active drugs. Despite the increased risk and abundance
of new prescriptions in older adults, most evaluation of the safety and effects of anti-seizure medications on
cognition have been done in short-term studies in younger cohorts. No anti-seizure medication prescribing
guidelines exist for older adults with mild cognitive impairment (MCI) or Alzheimer’s Disease and related
dementias (ADRD). Currently, little information exists regarding anti-seizure medication use including: whether
and how drug titration occurs, therapeutic drug monitoring, or how use may differ in older adults with dementia.
 In order to improve care, we must understand how and why particular anti-seizure medications are
prescribed. We currently have limited understanding of how prescribers make decisions, including weighing any
possible cognitive adverse effects, when adding and removing anti-seizure medications in older adults. These
knowledge gaps are barriers to developing safe, effective and evidence-based treatment strategies.
 This study will use a large representative study of older adults (the Health and Retirement Study linked to
Medicare data) to (1) understand differences in current use, titration, continuation, and laboratory monitoring of
anti-seizure medications in older adults with seizures, with and without ADRD, (2) examine the comparative
effect of commonly prescribed anti-seizure medications on cognitive decline and incident dementia, and (3)
recruit a national sample of prescribers (e.g. primary care, internal medicine, geriatrics, emergency medicine,
neurology) to understand decision-making in the context of anti-seizure medication prescription in older adults.
 My long-term goal is to develop an independent program focused on health services research to improve the
care for older adults with seizure and dementia. The completion of this project will lay the foundation for a career
of translating best evidence into practice. This project will form the backbone of an integrated training plan that
will refine my existing pharmacoepidemiologic and biostatistical skills. Further, it will allow me to develop new
knowledge in qualitative methods, geriatrics and cognitive decline. The training plan, focused mentorship and
proposed project will allow me to learn, develop and apply the skills necessary for a successful transition to
become an independent h...

## Key facts

- **NIH application ID:** 10913601
- **Project number:** 5K23AG080163-02
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Leah Blank
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $165,605
- **Award type:** 5
- **Project period:** 2023-09-01 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10913601

## Citation

> US National Institutes of Health, RePORTER application 10913601, Seizure, cognitive change and dementia: Understanding the use and safety of anti-seizure medications (5K23AG080163-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10913601. Licensed CC0.

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