Long-term cognitive outcome of bilateral subthalamic deep brain stimulation in Parkinson’s disease

Abstract

The effect of subthalamic deep brain stimulation (STN DBS) on cognition in Parkinson's disease (PD) remains controversial, and it is unclear which factors are related to cognitive decline and dementia after STN DBS, especially over the long term. To this end, we analyzed the cognitive outcome of 103 non-demented patients with PD who were followed-up for at least 12 months after bilateral STN DBS surgery. Preoperatively, the patients were evaluated with the Unified Parkinson's Disease Rating Scale and neuropsychological tests. The rate of global cognitive decline and the incidence of dementia during follow-up for up to 7 years (mean 42.4 ± 24.5 months) were calculated, and preoperative clinical and neuropsychological factors associated with postoperative global cognitive decline or dementia were analyzed. The prevalence of mild cognitive impairment (MCI) and its relation to later cognitive decline or dementia were also evaluated. The annual decline in the mini-mental state examination score was 0.4 ± 1.7 with impaired attention and executive function and a higher levodopa equivalent dose at baseline being the predictors of a faster global cognitive decline after STN DBS. Dementia developed in 13 patients with an incidence rate of 35.7 per 1,000 person-years. Impaired executive function at baseline predicted dementia. At baseline, 63.1 % of the patients had PD-MCI, and these patients were more likely to develop dementia than those without PD-MCI. This study showed that dysfunctions in the frontostriatal circuitry at baseline were associated with a risk of subsequent global cognitive decline and dementia in patients with PD who underwent STN DBS. In addition, preoperative PD-MCI was a risk factor for dementia after STN DBS.

Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments

“…DBS therapy tailored to individual patients in combination with multi-disciplinary care will optimize overall longterm outcomes. Mild cognitive impairment, particularly executive dysfunction, may predict the development of further cognitive decline in PD patients undergoing STN DBS [21] and a thorough neuropsychological assessment should be part of the presurgical diagnostic workup. In general, our practice is to favor STN DBS in younger patients likely requiring many years of effective stimulation unless speech or cognitive impairment clearly contraindicates this approach, in which case GPi DBS may be a little more ''lenient''.…”

Capgras Syndrome in a Patient with Parkinson's Disease after Bilateral Subthalamic Nucleus Deep Brain Stimulation: A Case Report

“…Capgras syndrome (CS) is a subtype of DMS in which a patient believes that a familiar person or place has been replaced by an imposter or duplicate [1, 2, 3, 4, 5]. This syndrome is highly associated with neurodegenerative disorders, and in particular with Lewy body dementia; however, few reports have described it in association with idiopathic Parkinson's disease (PD) with or without dementia [3, 4, 6, 7].…”

“…The effect of subthalamic nucleus deep brain stimulation (STN DBS) on cognition and neuropsychiatric function in PD remains controversial, and it is unclear which factors are related to cognitive decline, dementia, and psychiatric disease after STN DBS [5, 8, 9, 10, 11]. A recent study by Kim et al [5] suggested that a dysfunction in the frontostriatal circuitry (as inferred from tests of executive function) at baseline was associated with a risk of subsequent global cognitive decline and dementia in patients with PD who underwent STN DBS.…”

“…A recent study by Kim et al [5] suggested that a dysfunction in the frontostriatal circuitry (as inferred from tests of executive function) at baseline was associated with a risk of subsequent global cognitive decline and dementia in patients with PD who underwent STN DBS. This study additionally identified preoperative mild cognitive impairment as a risk factor for dementia after STN DBS [5].…”

“…A recent study by Kim et al [5] suggested that a dysfunction in the frontostriatal circuitry (as inferred from tests of executive function) at baseline was associated with a risk of subsequent global cognitive decline and dementia in patients with PD who underwent STN DBS. This study additionally identified preoperative mild cognitive impairment as a risk factor for dementia after STN DBS [5]. Several neuropsychiatric symptoms including mania, impulsivity, depression, and apathy are well known to emerge or to be exacerbated in the postoperative period, especially in patients with cognitive dysfunction [12].…”