Nomogram to Predict Cognitive State Improvement after Deep Brain Stimulation for Parkinson’s Disease

Abstract

Purpose: Parkinson’s disease (PD) is a common neurodegenerative disease, for which cognitive impairment is a non-motor symptom (NMS). Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for PD. This study established a nomogram to predict cognitive improvement rate after STN-DBS in PD patients. Methods: We retrospectively analyzed 103 PD patients who underwent STN-DBS. Patients were followed up to measure improvement in MoCA scores one year after surgery. Univariate and multivariate logistic regression analyses were used to identify factors affecting improvement in cognitive status. A nomogram was developed to predict this factor. The discrimination and fitting performance were evaluated by receiver operating characteristics (ROC) analysis, calibration diagram, and decision curve analysis (DCA). Results: Among 103 patients, the mean improvement rate of the MoCA score was 37.3% and the median improvement rate was 27.3%, of which 64% improved cognition, 27% worsened cognition, and 8.7% remained unchanged. Logistic multivariate regression analysis showed that years of education, UPDRSIII drug use, MoCA Preop, and MMSE Preop scores were independent factors affecting the cognitive improvement rate. A nomogram model was subsequently developed. The C-index of the nomogram was 0.98 (95%CI, 0.97–1.00), and the area under the ROC was 0.98 (95%CI 0.97–1.00). The calibration plot and DCA demonstrated the goodness-of-fit between nomogram predictions and actual observations. Conclusion: Our nomogram could effectively predict the possibility of achieving good cognitive improvement one year after STN-DBS in patients with PD. This model has value in judging the expected cognitive improvement of patients with PD undergoing STN-DBS.

A nomogram based on neuron-specific enolase and substantia nigra hyperechogenicity for identifying cognitive impairment in Parkinson’s disease

“…A higher initial UPDRS-III score suggests a more severe underlying pathology. Research has shown that the UPDRS-III score is positively correlated with the improvement rate of cognitive function after DBS implantation ( 45 ). Chen and colleagues generated a predictive model for CI in PD that combines age of onset, hypertension, baseline MoCA scores, UPDRS-III scores, and APOE ε4, achieving an AUC of 0.80 ( 46 ).…”

Consciousness and inward electromagnetic field interactions

“…Placing shields or introducing EMFs from external sources outside of the skull would hardly alter inward directed energies and would, hence, not appreciably alter our brain, mind or consciousness; this is what has been observed experimentally ( Lashley et al, 1951 ; Sperry et al, 1955 ). Similarly, implanted deep brain stimulating electrodes appear to produce too localized a perturbation to alter the mind’s EMF, although effects on cognition do occur in some patients ( Agashe et al, 2022 ; Chang et al, 2022 ). It has long been known that high strength magnetic fields of MRI scanners effect both human and animal subjects, producing dizziness, altered behavioral responses and cognitive impairment ( Antunes et al, 2012 ; Tkáč et al, 2021 ).…”

Functional Connectivity and Anxiety Improvement After Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease

“… 1 In addition, a variety of non-motor symptoms (NMS), such as mood disorders, cognitive impairments, sleep disorders, and autonomic dysfunction, may be observed. 2 , 3 Anxiety is one of the most common NMS of PD. Its prevalence among patients with PD is 31%, which is higher than that in patients with community or other diseases.…”