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This study demonstrates a significant association between elevated plasma p-tau217, a biomarker reflective of Alzheimer disease pathology, and cognitive decline in late-onset unexplained epilepsy (LOUE). Additionally, it identifies disrupted sleep microarchitecture—specifically reduced spindle-slow oscillation coupling—as a partial mediator of this association. Cognitive deficits were most severe in patients with refractory epilepsy, underscoring epilepsy severity as an important modifier in this relationship.
