Neurocognitive Differences in Attention, Memory, and Executive Functions Between People with Epilepsy and Healthy Controls: Evidence from Shiraz, Iran

Document Type : Original Article

Author

Department of Psychology, Higher Education Center of Eghlid, Eghlid, Iran

Abstract

This study investigated neurocognitive profiles in attention, memory, and executive functions among individuals with epilepsy compared to healthy controls in Shiraz, Iran. In a cross-sectional design, 121 participants (61 with epilepsy, 60 controls) aged 18–45 years were assessed using a standardized neuropsychological battery, including the Digit Span Test, Rey Auditory Verbal Learning Test (RAVLT), Stroop Color-Word Test, and Wisconsin Card Sorting Test (WCST). Data were analyzed using non-parametric Mann–Whitney U tests due to non-normal distributions. Results revealed that individuals with epilepsy exhibited significantly greater cognitive impairments across all domains: attention (U = 171.5, p < .001), memory (U = 135.5, p < .001), and executive functioning (U= 49.5, p < .001). The findings underscore substantial neurocognitive dysfunction associated with epilepsy, highlighting the need for integrated cognitive screening and tailored interventions within clinical care in the Iranian context. This study contributes to the growing cross-cultural evidence on epilepsy-related cognitive deficits and supports the adoption of holistic management approaches that address both seizure control and cognitive rehabilitation.

Keywords

Main Subjects


Baker, J., & Butler, C. (2024). Epilepsy and cognition. In Comorbidities and Social Complications of Epilepsy and Seizures: The cognitive, psychological and psychosocial impact of epilepsy (Vol. 25, p. 87).
Baxendale, S., Heaney, D., Thompson, P. J., & Duncan, J. S. (2017). Cognitive consequences of childhood-onset temporal lobe epilepsy across the adult lifespan. Neurology, 88(11), 1089–1095. https://doi.org/10.1212/WNL.0000000000003714
Dann, K. M., Veldre, A., Miles, S., Sumner, P., Hay, P., & Touyz, S. (2023). Measuring cognitive flexibility in anorexia nervosa: Wisconsin Card Sorting Test versus cued task-switching. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 28(1), 60.
Gerina, A., Sidamo, T., Dawit, M., Kedir, T. E., & Tadele, Y. (2025). Treatment Outcome of Epileptic Patients on Regular Follow-Up Care at the Neurology Clinic of Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia: A Retrospective Cohort Study. https://doi.org/10.21203/rs.3.rs-6335952/v1
Gupta, G., Kesri, R., Sachdeva, A., Matcheswalla, Y., Karia, S., & Sousa, A. D. (2022). Comorbid Neurocognitive Impairment in Patients with Epilepsy. Indian Journal of Mental Health, 9(3).
 Hasegawa, N., & Annaka, H. (2023). Long‐term effect associated with seizures and dynamic effect associated with treatment on cognitive dysfunction of adult patients with focal epilepsy as evaluated by the Trail Making Test. Epileptic Disorders, 25(5), 731-738. https://doi.org/10.1002/epd2.20137
Heaton, R. K. (1981). Wisconsin card sorting test. Psychological assessment resources.
Helmstaedter, C., Witt, J. A., & Hoppe, C. (2021). Cognitive screening in epilepsy: Where do we stand and where should we go? Epilepsy & Behavior, 121, 108097. https://doi.org/10.1016/j.yebeh.2021.108097
Jaffri, N., Hasan, S., & Vasmeen, R. (2022). Cognitive disturbances (attention, memory and executive functioning) among individuals with epilepsy and normal controls in Karachi, Pakistan. Rawal Medical Journal, 47(4), 841-844.
Lezak, M. D. (2004). Neuropsychological assessment. Oxford University Press, USA.
Loring, D. W., & Meador, K. J. (2016). Cognitive side effects of antiepileptic drugs. Epilepsy & Behavior, 64, 179-183. https://doi.org/10.1016/j.yebeh.2016.08.038
Millisecond Software (2021) [Computer software]. https://www. millisecond.com. Accessed Jan 2021
Mukaino, T. (2024). Memory impairments in temporal lobe epilepsy. Rinsho Shinkeigaku= Clinical Neurology. https://doi.org/10.5692/clinicalneurol.cn-001886
Ostrosky-Solís, F., and Lozano, A. (2006). Digit span: effect of education and culture. Int. J. Psychol. 41, 333–341. doi: 10.1080/00207590500345724
Sisakhti, M., Batouli, S. A. H., & Farrahi, H. (2023). The rey auditory verbal learning test: Age-, gender-and education-related normative data for the Iranian healthy population. Frontiers in Biomedical Technologies. https://doi.org/10.18502/fbt.v10i3.13162
Sobhani, V., Rezvani, Z., Meftahi, G. H., Ghahvehchi-Hosseini, F., & Hatef, B. (2022). The Linear and Nonlinear Indices of Electroencephalography Change in the Stroop Color and Word Test. Journal of Modern Rehabilitation. 16(2).  https://doi.org/10.18502/jmr.v16i2.9300
Soleymani, R., Jahangiri Zarkani, N., Amini Harandi, A., & Pakdaman, H. (2025). The cognitive burden of epilepsy: Assessing executive dysfunction in adult patients. Applied Neuropsychology: Adult, 1–10. https://orcid.org/0009-0009-6584-2333
Strauss, E., Sherman, E., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary.
Thompson, P. J., & Duncan, J. S. (2005). Cognitive decline in severe intractable epilepsy. Epilepsia, 46(11), 1780-1787. https://doi.org/10.1111/j.1528-1167.2005.00279.x
Upton, D., & Thompson, P. J. (2020). Executive functions and epilepsy: A review. Epilepsy & Behavior, 112, 107364. https://doi.org/10.1016/j.yebeh.2020.107364
Van der Elst, W., Van Boxtel, M. P., Van Breukelen, G. J., & Jolles, J. (2006). The Stroop color-word test: influence of age, sex, and education; and normative data for a large sample across the adult age range. Assessment, 13(1), 62-79. https://doi.org/10.1177/1073191105283427
Van Patten, R., Austin, T. A., Cotton, E., Chan, L., Bellone, J. A., Mordecai, K., & LaFrance, W. C. (2024). Cognitive performance in functional seizures compared with epilepsy and healthy controls: a systematic review and meta-analysis. The Lancet Psychiatry, 11(7), 516-525.
World Health Organization. (2019). Epilepsy: A public health imperative. World Health Organization. https://www.who.int/publications/i/item/epilepsy-a-public-health-imperative
Volume 1, Issue 4
December 2025
Pages 60-69
  • Receive Date: 11 August 2025
  • Revise Date: 24 September 2025
  • Accept Date: 03 October 2025
  • Publish Date: 01 December 2025