Seizure Risk Management in Alzheimer’s and Dementia Online

AD Seizure Risk Management Guide

An Evidence-Based Resource from Seagull Health’s SeizureSafe™ Platform

Executive Overview

This guide provides senior living administrators and clinical leads with essential insights into the significant challenge of seizure management in residents with Alzheimer’s disease (AD). Seizures are notably more prevalent in individuals with AD, often presenting subtly and leading to under-recognition, which can accelerate cognitive decline and increase adverse events. Although this guide focuses on AD, many of the outlined seizure risks and management principles are also relevant to other forms of dementia.

Effective management, underpinned by specialized staff education and robust protocols, is critical for enhancing resident safety, ensuring quality of care, maintaining regulatory compliance, and mitigating organizational risk. This document translates key research findings into actionable strategies and operational considerations for your facilities.

1. The Scope of the Challenge: Seizures in Alzheimer’s Disease

Seizures are often overlooked in residents with AD, but research shows they are far more common in this population compared to older adults without dementia. These seizures are frequently subtle and misinterpreted as routine dementia-related behaviors. For senior living leaders, this under-recognition creates hidden risks—such as avoidable hospital transfers, falls, regulatory issues, and increased family concerns.

1.1. Epidemiological Burden

Residents with Alzheimer’s have a 2–17 times higher risk of seizures compared to dementia-free older adults.
Studies suggest 8–10 seizures per 1,000 person-years among clinically diagnosed Alzheimer’s residents, with even higher rates when subtle episodes are included.
Subclinical epileptiform activity (SEA)—abnormal brain activity with no obvious outward symptoms—occurs in up to 40% of residents when monitored with an advanced EEG.
With global dementia rates expected to triple by 2050, seizure-related events will become a growing operational and clinical concern.

1.2 Clinical and Operational Impact

Cognitive Decline: Seizures and SEA are linked to faster declines in memory and daily functioning.
High Recurrence Risk: Once a seizure occurs, recurrence rates approach 70% within 7–8 months if untreated.
Increased Injuries: Seizures raise the risk of falls, fractures, aspiration pneumonia, and hospital transfers.
Family and Survey Concerns: A single poorly handled seizure event can trigger family complaints, survey findings, or legal exposure.

Why This Matters for Senior Living Leadership

Missed seizures are not just a clinical issue—they affect census stability, staffing efficiency, and regulatory readiness. Facilities with proactive seizure risk programs reduce avoidable emergencies and strengthen their quality metrics.

2. Identifying and Understanding Risk

Why This Matters for Senior Living Leadership

Recognizing which residents are most vulnerable to seizure activity is key to prevention and early intervention. In Alzheimer’s disease (AD), seizures often develop as the disease progresses and brain activity becomes more unstable. Leaders and care teams must understand these risk factors to integrate them into assessments, care planning, and staff education.

2.1. Key Risk Factors

Stage of Disease: Residents in moderate to severe AD are at significantly higher seizure risk.
History of Brain Injury or Stroke: These conditions further lower the brain’s seizure threshold.
Genetic Factors: Certain genetic mutations associated with AD (e.g., APOE4) are linked to increased seizure likelihood.
Sudden Behavioral or Cognitive Changes: Episodes of unexplained agitation, “blank stares,” or sudden withdrawal can indicate underlying seizure activity.
Medication Triggers: Certain commonly used medications—such as specific antipsychotics, antidepressants, and specific antibiotics—can lower seizure thresholds. Monitoring new prescriptions is essential.
Underlying Health Issues: Infections, dehydration, metabolic imbalances (e.g., low sodium), or poor nutrition can trigger seizure activity in vulnerable residents.

2.2. Operational Implications

Failure to identify and monitor these risk factors can lead to:

Unnecessary Hospital Transfers: Missed seizures are often misdiagnosed as strokes or behavioral events.
Falls and Injuries: Seizure-related falls can lead to costly incidents and potential survey deficiencies.
Increased Staff Burden: Without proper training, teams may struggle to recognize and respond effectively.
Family Concerns and Liability: Repeated unexplained incidents can erode trust and trigger complaints or legal review.

3. Strategic Management Principles for Senior Living Leadership

Seizure risk management in Alzheimer’s disease (AD) is not just a clinical responsibility—it is a leadership priority that affects resident safety, regulatory compliance, and operational performance. Leaders who embed seizure awareness into their policies, training programs, and quality initiatives create a safer environment for residents and a more confident, capable care team.

3.1 Leadership Commitment and Culture

Establish Seizure Awareness as a Core Priority: Make seizure recognition and response a standing agenda item for leadership and clinical meetings.
Set the Tone for Staff Training: Ensure that all staff understand that identifying subtle seizure signs is part of their daily duties, not an optional skill.
Integrate into Quality Goals: Treat seizure prevention and accurate documentation as quality metrics, aligning them with QAPI objectives and survey readiness.

3.2 Staff Education and Competency

Role-Specific Training: Offer tiered training modules for direct care staff, nurses, and management, emphasizing recognition, response, and documentation.
Practical Tools: Supply easy-to-use resources, such as Seizure Observation Checklists and Initial Alert Cards, and ensure they are incorporated into daily workflows.
Ongoing Competency Checks: Include seizure recognition scenarios in onboarding, annual in-services, and mock surveys.

3.3 Standardized Observation and Documentation

Structured Observation: Requires staff to document the time, duration, and behaviors associated with any suspected seizure episode.
Avoid Vague Language: Replace terms like “acting out” or “confused” with clear descriptions of what was observed (e.g., “staring blankly for 30 seconds, unresponsive to cues”).
Shift Handoffs: Ensure seizure observations are consistently communicated during shift change reports to avoid missed patterns.

3.4 Policy Development and Risk Planning

Seizure Risk Screening: Add seizure risk factors (e.g., history of TBI, stroke, or new medications) to resident admission and quarterly assessments.
Response Protocols: Define clear steps for escalation when staff suspect seizure activity, including when to notify nursing or call emergency services.
Incident Review: Incorporate suspected seizure events into monthly QAPI or safety committee reviews.

3.5 Family and Care Partner Engagement

Educate Families: Provide families with basic information on seizure signs, particularly those that may be mistaken for symptoms of dementia.
Collaborative Communication: Encourage families to report observations made during visits and document them in the resident’s record.
Transparency: Address seizure-related incidents with timely updates to families, building trust and avoiding miscommunication.

4. Implementation Roadmap and Future Directions

Transforming seizure risk management from an ad-hoc process into a proactive, structured program requires deliberate planning and leadership alignment. This section outlines the core steps for implementing a practical seizure management framework in senior living settings, followed by key trends shaping the future of care.

4.1 Stepwise Implementation Framework

Step 1: Leadership Buy-In and Policy Review

Begin by aligning administrators, clinical managers, and quality leads on the importance of implementing seizure risk protocols.
Conduct a review of existing policies to identify gaps in seizure recognition, documentation, and response.
Establish seizure risk management as part of your facility’s safety and quality initiatives.

Step 2: Staff Education and Tool Deployment

Implement foundational training on recognizing subtle seizure signs and response protocols for all staff.
Introduce tools such as the Seizure Observation Checklist and Initial Alert Card to guide daily practice.
Use real-life scenarios and case examples during in-service sessions to reinforce learning.

Step 3: Integration into Daily Workflows

Embed observation checklists into shift reports, incident logs, or EMR notes.
Require that seizure-related observations are communicated at every handoff between shifts.
Assign a nurse or quality lead to track trends and review all documented seizure-related events on a weekly basis.

Step 4: Quality Assurance and Continuous Improvement

Include seizure-related incidents in monthly QAPI reviews to identify patterns and improvement opportunities.
Track metrics such as reduced fall incidents or avoidable ER transfers as key success indicators.
Encourage staff to provide feedback on the effectiveness of training and tools, and make adjustments as needed.

4.2 Future Directions in Seizure Risk Management

Advanced Diagnostic Tools

Extended EEG monitoring and AI-driven predictive algorithms are emerging technologies that can help identify seizure risk earlier and more accurately, particularly for non-motor events.

Medication Optimization

Collaborative medication reviews with neurologists or pharmacists are essential to minimize the use of drugs that lower the seizure threshold and to ensure the safe use of anti-seizure medications (ASMs).

Technology Integration

Wearable devices and passive monitoring systems may soon provide real-time alerts for subtle seizure activity, creating new opportunities for early intervention.

Research and Data-Driven Insights

Ongoing research into seizure patterns in dementia will inform the development of the next generation of protocols. Facilities that collect and analyze observational data will be better positioned to adopt these innovations.

Conclusion and Leadership Call-to-Action

Seizure risk management in Alzheimer’s disease (AD) is not a peripheral concern—it is a critical component of resident safety, operational stability, and quality care. Subtle seizure events, if left unrecognized, can lead to avoidable emergencies, staff burnout, and regulatory scrutiny. Leadership must take an active role in embedding seizure awareness and structured protocols across all levels of care.

The strategies outlined in this guide—ranging from staff training and observation tools to QAPI integration and family engagement—are designed to be immediately actionable within senior living settings. Facilities that adopt these practices strengthen both resident outcomes and organizational resilience.

Your Call-to-Action:

Prioritize Education: Ensure every care team member can identify and report subtle seizure activity.
Standardize Documentation: Use observation checklists and structured reporting to create clear, defensible records.
Align with QAPI Goals: Incorporate seizure prevention into your quality metrics and survey readiness initiatives.
Engage Families: Foster transparency and trust by involving families in discussions about seizure risk and care planning.
Invest in Continuous Improvement: Use pilot programs, feedback loops, and emerging tools to stay ahead of evolving best practices.

Proactive seizure management is both a clinical necessity and a competitive advantage in senior living. By taking action now, you can prevent harm, reduce costs, and position your community as a leader in dementia care excellence.

References

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Amatniek J., Hauser W. A., DelCastillo-Castaneda C., et al. Incidence and Predictors of Seizures in Patients with Alzheimer’s Disease. Journal of Neurology. 2006;253(12):1559–1564.
Vossel K. A., Tartaglia M. C., Nygaard H., et al. Epileptic activity in Alzheimer’s disease: clinical features and network hyperexcitability. Brain. 2013;136(12):434–454.
Rodríguez‐Labrada R., Gama H., León‐Juárez M., et al. Interictal epileptiform discharges in Alzheimer’s disease and other dementias: a scoping review. Frontiers in Aging Neuroscience. 2023; doi:10.3389/fneur.2023.126113.
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DiFrancesco M., Bastidas C., Chen W., et al. Epilepsy in Autosomal Dominant Alzheimer Disease. Neurology. 2017;89(17):1801–1808.
Belcastro V., Praticò A. D., Thomas A., et al. Levetiracetam efficacy and tolerability in Alzheimer’s patients with new-onset seizures: an observational study. Neurotherapeutics. 2007;4(3):454–461.