The effect of anti-seizure medications on Alzheimer's disease (AD) risk and AD-related symptoms: A scoping review

Background: As the fastest-growing segment of the population, adults over 65 are at the most significant risk for Alzheimer's disease (AD). Older adults often use anti-seizure medications (ASMs), which can negatively impact cognitive function, mood, and behavior, mimicking AD or its symptoms. Understanding the effects of ASMs across diverse older adults is crucial, given that some ethnoracial groups are at higher risk for AD or more severe symptoms compared to non-Hispanic Whites. Objective: To summarize the current evidence on the association of ASMs with AD risk and AD-related symptoms and explore the inclusion of ethnoracial minority groups in these studies. Methods: Data sources included PubMed/MEDLINE, EMBASE, and SCOPUS for English-language studies published between 1990–2024. Selected studies were peer-reviewed, cross-sectional, longitudinal, case-control, and clinical trials on AD dementia or related symptoms and ASMs. Study quality was rated by the Oxford Centre for Evidence-Based Research Medicine. Results: A total of 27 studies with 1,241,796 participants were included. Data on AD risk from level IB-IIIB evidence studies showed mixed results, with some indicating an increased association with ASM use [OR = 1.05–1.16, 95% CI: 1.01–1.24]. Studies on AD-related symptoms from level IB-IV evidence also showed mixed results. Only three North American studies explicitly included race/ethnicity; most were conducted in European countries. Conclusions: ASM use may be modestly associated with an increased risk of AD among the older adult population, but current data are inconclusive. The association of ASMs on AD-related symptoms varied. Future studies should emphasize reporting sociodemographic data and include diverse cohorts to enhance the applicability of findings.