Does Personality Change Follow Deep Brain Stimulation in Parkinson's Disease Patients?

Abstract

Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.

Essentials of Informed Consent to Psychedelic Medicine

“…[18][19][20] There are few comparable interventions; deep brain stimulation may be one, though the evidence for personality change is contested. 36,37 Clinicians should discuss potential personality changes during the informed consent process. Moreover, because psychedelics may temporarily alter patient values, making patients more empathetic and possibly susceptible to persuasion, practitioners should advise patients not to make major life decisions or put themselves in compromising positions in the weeks or months following psychedelic administration.…”

“…While personality changes can also occur in other settings, such as psychotherapy, what potentially distinguishes psychedelics from other therapies is how quickly changes can occur and how little exposure is required . There are few comparable interventions; deep brain stimulation may be one, though the evidence for personality change is contested …”

Emerging Neurotechnologies: Implications for Professional Relations and Communication

“…55 However, these distinctions may be subjective and vary both across cultures and time; they have certainly long been debated in psychiatry. 56 As state-of-the-art medical devices present increasing potential to treat or augment previously intractable conditions and even alter one's personality, 43,57,58 the challenge for providers will be to define appropriate and reasonable applications for increasingly capable neurotherapeutics.…”

Public Perceptions of Neurotechnologies Used to Target Mood, Memory, and Motor Symptoms

“…When it comes to medical neurotechnologies, there has been a particular focus in the academic literature on DBS, which may be in part due to the neuroethical debate around whether, and to what degree, DBS may impact a patient's personality and related characteristics. [15][16][17][18][19][20][21] There have been numerous evaluations of psychosocial impacts of DBS devices for psychiatric and movement disorders over the past 10-15 years. There have also been some qualitative studies of TMS treatments during this time; [50][51][52][53] however, only recently has there been a focused examination of MRgFUS.…”