Abstract
People with functional seizures (FS) have frequent and disabling cognitive dysfunction and mental health symptoms, with low quality of life. However, interrelationships among these constructs are poorly understood. In this meta-analysis, we examined associations between objective (i.e. performance-based) cognitive testing and self-reported (i) mental health, (ii) cognition, and (iii) quality of life in FS.
: We searched MEDLINE, Embase, PsycINFO, and Web of Science, with the final search on June 10, 2024. Inclusion criteria were studies documenting relationships between objective cognitive test scores and self-reported (i.e. subjective) mental health, cognition, and/or quality of life in adults with FS. Exclusion criteria were mixed FS/epilepsy samples. A modified Newcastle-Ottawa Scale evaluated risk of bias. This project is registered as CRD42023392385 in PROSPERO.
: Initially, 4,054 unique reports were identified, with the final sample including 24 articles of 1,173 people with FS. Mean age was 35.9 (SD = 3.9), mean education was 12.6 (SD = 1.3), and proportion of women was 73.9%. Risk of bias was moderate, due in part to inconsistent reporting of confounding demographic variables. Significant relationships were found between global objective cognition and global self-reported mental health (
= 21, Z = -0.23 [0.04], 95% CI = -0.30, -0.16), depression (
= 11, Z = -0.13 [0.05], 95% CI = -0.21, -0.04), cognition (
= 5, Z = -0.16 [0.05], 95% CI = -0.26, -0.06), and quality of life (
= 5, Z = -0.17 [0.05], 95% CI = -0.24, -0.10). Exploratory analyses showed associations between select cognitive and mental health constructs.
: Objective cognition is reliably associated with self-reported mental health, cognition, and quality of life in people with FS. Scientific and clinical implications are discussed.