Non-motor predictors of 36-month quality of life after subthalamic stimulation in Parkinson disease

Abstract

To identify predictors of 36-month follow-up quality of life (QoL) outcome after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson’s disease (PD). In this ongoing, prospective, multicenter international study (Cologne, Manchester, London) including 73 patients undergoing STN-DBS, we assessed the following scales preoperatively and at 6-month and 36-month follow-up: PD Questionnaire-8 (PDQ-8), NMSScale (NMSS), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). We analyzed factors associated with QoL improvement at 36-month follow-up based on (1) correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions and receiver operating characteristic curves using a dichotomized variable “QoL responders”/“non-responders”. At both follow-ups, NMSS total score, SCOPA-motor examination, and -complications improved and LEDD was reduced significantly. PDQ-8 improved at 6-month follow-up with subsequent decrements in gains at 36-month follow-up when 61.6% of patients were categorized as “QoL non-responders”. Correlations, linear, and logistic regression analyses found greater PDQ-8 improvements in patients with younger age, worse PDQ-8, and worse specific NMS at baseline, such as ‘difficulties experiencing pleasure’ and ‘problems sustaining concentration’. Baseline SCOPA scores were not associated with PDQ-8 changes. Our results provide evidence that 36-month QoL changes depend on baseline neuropsychological and neuropsychiatric non-motor symptoms burden. These findings highlight the need for an assessment of a wide range of non-motor and motor symptoms when advising and selecting individuals for DBS therapy.

Predictors of Global Non-Motor Symptoms Burden Progression in Parkinson’s Disease. Results from the COPPADIS Cohort at 2-Year Follow-Up

“…Awareness of the progression of these symptoms in clinical practice, with the aim to introduce interventions to reduce NMS burden progression when possible, could be important. As example, bilateral subthalamic stimulation (STN-DBS) improved significantly the global SNMS burden and QoL in advanced PD patients after 36 months but not in patients who received the standard-of-care medical therapy [ 19 ]. Since global NMS burden impacts the patient’s QoL [ 8 ] and its progression worsens QoL [ 13 ], understanding the role global NMS plays in PD is very relevant.…”

The Contribution of Subthalamic Nucleus Deep Brain Stimulation to the Improvement in Motor Functions and Quality of Life

“…54 Motor as well as nonmotor symptoms contribute to QoL. 55,56 It has been shown that nonmotor symptoms are even strongly correlated to QoL than motor symptoms 18,57 QoL 56 EARLYSTIM did not assess nonmotor symptoms with an adequate scale 58 as this was not yet available at the time of the study planning. However, having detailed data on these aspects would possibly help explain a larger part of the QoL changes and thereby might better help explain the sweet spot relations.…”

Multicenter Validation of Individual Preoperative Motor Outcome Prediction for Deep Brain Stimulation in Parkinson’s Disease

“…Better understanding of the STN itself can lead to more stable motor improvements as well [11]. Moreover, increasing insights in the clinical non-motor characteristics, genetic profiles, and neurophysiological characteristics and their relation with DBS outcome have promising potential to improve patient selection, counseling, and outcome prediction [18,42]. All these approaches do not exclude each other and can improve DBS outcome in PD in a complementary way in the future.…”