Topological alterations in older adults with temporal lobe epilepsy are distinct from amnestic mild cognitive impairment.

Epilepsy incidence and prevalence peaks in older adults, yet systematic studies of brain aging and epilepsy remain limited. We investigated topological network disruption in older adults with temporal lobe epilepsy (TLE; age > 55 years). Additionally, we examined the potential network disruption overlap between TLE and amnestic mild cognitive impairment (aMCI), the prodromal stage of Alzheimer disease. Measures of network integration ("global path efficiency") and segregation ("transitivity" and "modularity") were calculated from cortical thickness covariance from 73 TLE subjects, 79 aMCI subjects, and 70 healthy controls. Compared to controls, TLE patients demonstrated abnormal measures of segregation (increased transitivity and decreased modularity) and integration (decreased global path efficiency). aMCI patients also displayed increased transitivity and decreased global path efficiency, but these differences were less pronounced than in TLE. At the local level, TLE patients demonstrated decreased local path efficiency focused in the bilateral temporal lobes, whereas aMCI patients had a more frontal-parietal distribution. These results suggest that network disruption at the global and local level is present in both disorders, but global disruption may be a particularly salient feature in older adults with TLE. These findings motivate further research into whether these network changes have distinct cognitive correlates or are progressive in older adults with epilepsy.