A growing body of evidence has demonstrated a link between Alzheimer disease (AD) and epilepsy. Late-onset epilepsy and epileptiform activity can precede cognitive deterioration in AD by years, and its presence has been shown to predict a faster disease course. In animal models of AD, amyloid and tau pathology are linked to cortical network hyperexcitability that precedes the first signs of memory decline. Thus, detection of epileptiform activity in AD has substantial clinical importance as a potential novel modifiable risk factor for dementia. In this Review, we summarize the epidemiological evidence for the complex bidirectional relationship between AD and epilepsy, examine the effect of epileptiform activity and seizures on cognition in people with AD, and discuss the precision medicine treatment strategies based on the latest research in human and animal models. Finally, we outline some of the unresolved questions of the field that should be addressed by rigorous research, including whether particular clinicopathological subtypes of AD have a stronger association with epilepsy, and the sequence of events between epileptiform activity and amyloid and tau pathology.

越来越多的证据表明阿尔茨海默病 (AD) 与癫痫之间存在联系。迟发性癫痫和癫痫样活动可能会先于 AD 认知恶化数年，并且它的存在已被证明可以预测更快的病程。在 AD 动物模型中，淀粉样蛋白和 tau 蛋白病理学与出现记忆衰退迹象之前的皮质网络过度兴奋有关。因此，检测 AD 中的癫痫样活动作为痴呆症潜在的新型可改变危险因素具有重大的临床重要性。在这篇综述中，我们总结了AD与癫痫之间复杂的双向关系的流行病学证据，研究了癫痫样活动和癫痫发作对AD患者认知的影响，并根据人类和动物的最新研究讨论了精准医疗治疗策略楷模。最后，我们概述了该领域一些应通过严格研究解决的未解决问题，包括 AD 的特定临床病理亚型是否与癫痫有更强的关联，以及癫痫样活动与淀粉样蛋白和 tau 蛋白病理学之间的事件顺序。