Jeff Will’s unusual episodes of confusion and memory lapses began several years ago, before he turned 70. At his electrical contracting business in Erie, Pennsylvania, coworkers noticed he would zone out during meetings and forget conversations. At home, he sometimes wandered aimlessly or behaved oddly, such as dressing inappropriately or filling his golf bag with leaves. On one occasion, state police contacted his wife after Mr. Will, who had driven to a local YMCA to play pickleball, became disoriented and crashed his car into a bush.

Despite numerous visits to neurologists, psychiatrists, and cognitive specialists over nearly three years, no diagnosis explained his symptoms. Brain scans and cognitive tests returned results typical for his age, and some doctors attributed the issues to stress. Eventually, the Wills sought care at the Cleveland Clinic, where doctors identified that Mr. Will was experiencing subtle epileptic seizures responsible for his dementia-like symptoms. After starting anti-seizure medication, his confusion and memory loss markedly improved.

Mr. Will’s case highlights growing research on the link between epilepsy and dementia, two conditions that commonly affect older adults. Studies show that individuals with epilepsy have a two- to threefold increased risk of developing dementia, and conversely, those with dementia face a similar elevated risk of seizures. Medical experts emphasize that this bidirectional relationship is often overlooked, despite being highly relevant as populations age.

Seizures in older adults frequently manifest as subtle cognitive changes rather than dramatic convulsions. These episodes can include periods of unresponsiveness, confusion, and memory problems, sometimes lasting hours or days. Known as absence or temporal lobe seizures, they can be difficult to recognize without specialized testing such as prolonged electroencephalograms (EEGs). These subtle seizures may accelerate cognitive decline or mimic symptoms of Alzheimer’s disease and other dementias.

Neurologists suggest that epileptic brain activity may disrupt memory formation by interfering with normal electrical signaling. Some researchers propose that the seizure-related “hyper-excitability” could contribute to neuronal damage, creating a cycle that exacerbates neurodegeneration. Common dementia-related proteins like amyloid and tau may also increase seizure risk. Additionally, vascular, frontotemporal, and Lewy body dementias have been associated with higher seizure incidence.

Approximately 7 million people in the United States live with dementia, while an estimated 10 million older adults have mild cognitive impairment, a potential precursor to dementia. Around 3 million adults currently have active epilepsy, with many cases beginning in late adulthood without clear causes such as stroke or brain injury. Experts estimate that at least 10 percent of patients with dementia or mild cognitive impairment experience seizures or abnormal brain electrical activity.

Treatment considerations can be complex. Some anti-seizure drugs may worsen cognition, requiring careful selection of medications. Moreover, clinical trials for new Alzheimer's therapies have typically excluded patients with epilepsy, limiting guidance for this population. Physicians may also underdiagnose coexisting epilepsy in dementia patients due to subtle seizure presentations and limited routine EEG use.

At the Cleveland Clinic, Mr. Will underwent a five-day continuous EEG monitoring, with video surveillance capturing his seizures, which involved staring spells and involuntary movements typical of temporal lobe epilepsy. Following treatment initiation with Keppra, his seizures and cognitive episodes ceased. While he retains some memory gaps from the affected period, he no longer meets criteria for dementia and has regained many everyday cognitive functions.

Experts advocate for increased awareness and routine screening for epileptic activity in patients presenting with cognitive decline. Improved recognition and treatment of seizures in this population may prevent misdiagnoses and offer opportunities to stabilize or improve cognitive symptoms. As research advances, a more integrated approach addressing the intersection of epilepsy and dementia may enhance care for aging patients experiencing these overlapping neurological conditions.