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Development and Application of the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE): Initial Results From a Multi-Center Study of Adults With Temporal Lobe Epilepsy
Objective: To describe the development and application of a consensus-based, empirically driven approach to cognitive diagnostics in epilepsy research-The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) and to assess the ability of the IC-CoDE to produce definable and stabl...
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Published in: | Neuropsychology 2023-03, Vol.37 (3), p.301-314 |
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Main Authors: | , , , , , , , , , , , , |
Format: | Article |
Language: | English |
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Citations: | Items that cite this one |
Online Access: | Get full text |
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Summary: | Objective: To describe the development and application of a consensus-based, empirically driven approach to cognitive diagnostics in epilepsy research-The International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) and to assess the ability of the IC-CoDE to produce definable and stable cognitive phenotypes in a large, multi-center temporal lobe epilepsy (TLE) patient sample. Method: Neuropsychological data were available for a diverse cohort of 2,485 patients with TLE across seven epilepsy centers. Patterns of impairment were determined based on commonly used tests within five cognitive domains (language, memory, executive functioning, attention/processing speed, and visuospatial ability) using two impairment thresholds (≤1.0 and ≤1.5 standard deviations below the normative mean). Cognitive phenotypes were derived across samples using the IC-CoDE and compared to distributions of phenotypes reported in existing studies. Results: Impairment rates were highest on tests of language, followed by memory, executive functioning, attention/processing speed, and visuospatial ability. Application of the IC-CoDE using varying operational definitions of impairment (≤1.0 and ≤1.5 SD) produced cognitive phenotypes with the following distribution: cognitively intact (30%-50%), single-domain (26%-29%), bi-domain (14%-19%), and generalized (10%-22%) impairment. Application of the ≤1.5 cutoff produced a distribution of phenotypes that was consistent across cohorts and approximated the distribution produced using data-driven approaches in prior studies. Conclusions: The IC-CoDE is the first iteration of a classification system for harmonizing cognitive diagnostics in epilepsy research that can be applied across neuropsychological tests and TLE cohorts. This proof-of-principle study in TLE offers a promising path for enhancing research collaborations globally and accelerating scientific discoveries in epilepsy.
Key Points
Question: Can a harmonized model for diagnosing cognitive disorders in epilepsy be used to enhance research collaborations in multi-site studies. Findings: We provide proof-of-principle that our harmonized model produces stable cognitive profiles across six U.S.-based samples of adults with TLE, regardless of the test measures used or the impairment thresholds applied. Importance: Using a common classification system for cognitive diagnostics in epilepsy research, we offer a promising path for enhancing research collaborations globally and acce |
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ISSN: | 0894-4105 1931-1559 |
DOI: | 10.1037/neu0000792 |