Objective  To systematically review the impact of new-generation an-tiepileptic drug (AED) regimens on cognitive function in elderly Chinese patients with epilepsy, and to provide evidence-based evidence for rational clinical medication.

Methods  Databases including PubMed, Embase, the Cochrane Library, CNKI, VIP, and WanFang Data were searched electronically for randomized controlled trials (RCTs) on the efficacy of treatment regimens for new-generation AEDs (including gabapentin, levetiracetam, lamotrigine, topiramate, oxcarbazepine, lacosamide, and perampanel) in elderly Chinese patients with epilepsy from inception to August 31, 2025. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using RevMan 5.4 and R 4.4.2 softwares.

Results  A total of 27 RCTs involving 2,469 patients were included. The results of the Meta-analysis showed that compared with monotherapy with traditional AEDs (the control group), regimens containing new-generation AEDs (the experimental group) significantly improved the clinical effective rate [OR=3.38, 95%CI (2.62, 4.36)] and reduced the incidence of adverse drug events [OR=0.48, 95%CI (0.27, 0.85)]. Regimens containing new-generation AEDs could improve global cognitive function scores [SMD=3.95, 95%CI (0.28, 7.62)]. Further subgroup analysis based on different assessment scales revealed that, the overall cognitive function scores in the experimental group assessed using the MoCA scale were higher than those in the control group [SMD=1.97, 95%CI (0.98, 2.95)].

Conclusion  Current evidence suggests that treatment regimens incorporating next-generation AEDs may demonstrate a certain trend toward improving cognitive function. Although the findings are consistent, this conclusion requires further validation through more high-quality studies due to the high heterogeneity among the studies.

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