Early Warning Signs of Seizures in Dementia Patients: Symptoms, Risks & Care Strategies

Seizures in dementia patients frequently go unrecognized because they can appear in subtle and atypical ways. Many caregivers and healthcare providers may confuse these signs with normal fluctuations associated with dementia rather than recognizing them as seizure activity. By identifying these early warning signs, it is possible to implement timely interventions and improve management, which can ultimately enhance the quality of life for individuals with Alzheimer’s disease (AD) and other forms of dementia.

Recognizing Seizures in Dementia

Seizures in individuals with dementia often manifest as behavioral or cognitive symptoms, making them harder to detect compared to convulsive seizures. Some common early signs include brief memory lapses, experiences of déjà vu or jamais vu, sudden interruptions in speech, and unexplained emotional shifts such as sudden fear or euphoria. Additionally, sensory disturbances, such as a metallic taste or unusual stomach sensations, have been reported (Vossel, 2023). Changes in behavior and mood can also serve as warning signs. Increased agitation, emotional outbursts, or an unexpected withdrawal from social interactions may indicate seizure activity (Giorgi et al., 2020). Cognitive fluctuations, such as sudden confusion, significant short-term memory lapses, and difficulty recognizing familiar people or places, can also suggest seizures rather than the normal progression of dementia (Horváth et al., 2016).

Neurological signs such as repetitive movements, loss of balance, and myoclonus (brief, involuntary muscle jerks) may indicate underlying seizure activity (Gao et al., 2021; Reyes-Marin et al., 2021). Another important indicator is post-seizure confusion, also known as post-ictal states, which can manifest as prolonged drowsiness, confusion, or lethargy following an episode (Zhao et al., 2022). Since these symptoms can be subtle and may resemble the typical decline associated with dementia, caregivers and healthcare providers must be vigilant in distinguishing them from normal disease progression.

Are Seizures an Early Indicator of Alzheimer’s Disease?

The relationship between seizures and AD is complex and bidirectional. Research indicates that seizures may not only be more prevalent in patients with Alzheimer’s but can also emerge before cognitive symptoms appear. Some studies suggest that epileptiform activity can manifest prior to the accumulation of amyloid-beta plaques, a key hallmark of Alzheimer’s disease (Minkeviciene et al., 2009). Additionally, adults with epilepsy of unknown origin have a higher risk of developing dementia later in life (Sarkis et al., 2016). Even in instances where seizures are not visibly apparent, subclinical epileptiform activity has been linked to accelerated cognitive decline. This suggests that abnormal electrical activity in the brain can contribute to a more rapid deterioration of memory and executive function in Alzheimer’s patients (Vöglein et al., 2020). Further research indicates that seizures and cognitive decline may occur simultaneously or that seizure activity could be detected years before a formal diagnosis of dementia is made (Xu et al., 2021).

What Caregivers Should Watch For

Caregivers play a vital role in identifying seizure activity in patients with dementia. They should watch for symptoms such as frequent episodes of confusion, unresponsiveness, sudden mood swings, agitation, staring spells, repetitive behaviors, unexplained emotional changes, or muscle twitches. If these symptoms occur frequently or seem to worsen over time, it is advisable to consult a neurologist for further evaluation. An electroencephalogram (EEG) can be helpful in detecting seizure activity, even if there are no obvious convulsions present.

Why Recognizing Seizures in Dementia Matters

Recognizing seizures in dementia patients is crucial because early detection can enhance patient care. If seizures go undiagnosed, their symptoms can significantly contribute to cognitive decline. By understanding the link between epilepsy and neurodegeneration, healthcare providers and caregivers can implement early intervention strategies that may slow disease progression and improve patients’ quality of life. Identifying the signs of seizures and seeking appropriate medical attention can lead to better treatment options, more personalized care plans, and improved long-term outcomes.

References

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Horváth, A., Szucs, A., Barcs, G., & Kamondi, A. (2016). Epileptic seizures in Alzheimer disease: A review. Alzheimer Disease & Associated Disorders, 30(2), 186–192. https://doi.org/10.1097/WAD.0000000000000134

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Reyes-Marin, K. E., & Zegarra-Valdivia, J. A. (2021). Seizure susceptibility in Alzheimer’s disease. Medical Research Archives, 9(5), 1–14. https://doi.org/10.18103/mra.v9i5.2408

Sarkis, R. A., Dickerson, B. C., Cole, A. J., & Chemali, Z. N. (2016). Clinical and neurophysiologic characteristics of unprovoked seizures in patients diagnosed with dementia. The Journal of Neuropsychiatry and Clinical Neurosciences, 28(1), 56–61. https://doi.org/10.1176/appi.neuropsych.15060143

Vöglein, J., Ricard, I., Noachtar, S., Kukull, W. A., Dieterich, M., Levin, J., & Danek, A. (2020). Seizures in Alzheimer’s disease are highly recurrent and associated with a poor disease course. Journal of Neurology, 267(9), 2941–2948. https://doi.org/10.1007/s00415-020-09937-7

Vossel, K. (2023). Putting the brakes on accelerated cognitive decline in Alzheimer’s disease with epileptic activity. Journal of Alzheimer’s Disease, 94(4), 1075–1077. https://doi.org/10.3233/JAD-230613

Xu, Y., Lavrencic, L., Radford, K., Booth, A., Yoshimura, S., Anstey, K. J., Anderson, C. S., & Peters, R. (2021). Systematic review of coexistent epileptic seizures and Alzheimer’s disease: Incidence and prevalence. International Journal of Geriatric Psychiatry, 36(3), 421–436. https://doi.org/10.1002/gps.5465

Zhao, N., Chen, H., Zhang, W., Yao, J., Tu, Q., Yu, X., & Sun, X. (2022). Bidirectional influences between seizures and dementia: A systematic review and meta-analysis. International Journal of Geriatric Psychiatry, 37(2), 1–10. https://doi.org/10.1002/gps.5723