Despite the high prevalence of cognitive deficits in older people with epilepsy (PWE), their ability to judge and make decisions in daily life remains unexplored. In 61 older PWE (55-90 years) from the multicenter BRain Aging and Cognition in Epilepsy (BrACE) study, we examined everyday judgment, as measured by the Test of Practical Judgment (TOP-J: 9 questions, score range = 0-27
higher score = better judgment) and evaluated its association with clinical and demographic characteristics, global cognition, neuropsychological performance, subjective cognition, and quality of life (QOL). In our participants (mean age ± standard deviation [SD] = 66.3 ± 6.57 years
57.4% female), >
50% scored in the range observed in individuals with mild cognitive impairment (≤21) and 10% in the range similar to people with dementia (≤16). Multivariable analysis revealed that education was the only demographic factor associated with TOP-J performance. Pearson correlation analysis revealed that lower TOP-J scores were associated with lower global cognition, language, and abstraction/executive function. Lower TOP-J scores were also associated with poorer QOL and self-reported cognitive complaints. These data suggest that the TOP-J may be a viable screening tool for early identification of reduced judgment. This could guide appropriate interventions in clinical practice, especially when older PWE present with deficits in language and executive function.