Predictors of cognitive and psychosocial outcome after STN DBS in Parkinson's Disease

Smeding, Harriët; Speelman, Johannes D.; Huizenga, Hilde M.; Schuurman, P. Richard; Schmand, Ben

doi:10.1136/jnnp.2007.140012

Cited by 171 publications

(182 citation statements)

References 39 publications

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“…Usually, the MDRS is used as a neuropsychological screening instrument that gives only a rough impression of global cognitive functioning. We chose this test to categorise our patients because we were interested in the informative value of a global cognitive score on changes in QoL after STN-DBS rather than in a specific neuropsychological profile and its impact on changes in QoL after STN like what has been done in other studies before [5,6]. As expected, detailed sub-analysis of the neuropsychological baseline data demonstrates that the STN-DBS patients in the lowest quartile of the MDRS are significantly impaired in other neuropsychological tasks such as verbal fluency, working memory, memory and attention.…”

Section: Discussionmentioning

confidence: 99%

“…So these recommendations are based on non-randomised studies with small sample sizes, case reports and the clinical impression. There are several risk factors for a cognitive decline after STN-DBS such as advanced age, impaired attention and low levodopa response at baseline, higher axial scores on the Unified Parkinson's Disease Rating Scale (UPDRS) part III in the medication of condition and a higher levodopa equivalence dosage at baseline [5,6]. And there are also preoperative factors that predict a positive effect of STN-DBS on quality of life (QoL) such as cumulative daily 'off' time, dyskinesia scores and performance on psychiatric scales at baseline [Daniels submitted].…”

Section: Introductionmentioning

confidence: 99%

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Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease

Witt

Daniels

Krack

et al. 2011

Journal of the Neurological Sciences

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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) inParkinson's disease (PD). Dementia is considered as a contraindication for STN-DBS. However, no controlled study assessed the impact of STN-DBS on the QoL and motor outcome in PD patients with a borderline global cognitive impairment. We studied clinical baseline and progression parameters in a cohort of STN-DBS patients with a global cognitive score still in the non-demented range but scoring in the lowest quartile of the Mattis Dementia Rating Scale (MDRS), a measure of global cognitive functioning. Data from a German randomised controlled study comparing DBS (60 patients) with best medical treatment (BMT, 59 patients) were analysed. Changes in patients' QoL scores were assessed using the Parkinson's disease questionnaire (PDQ-39) at baseline and at the 6 months follow up. Patients were split into four groups according to their MDRS performance at baseline and these groups were compared in the context of motor outcome and QoL. Twelve out of sixty patients of the STN-DBS group scored in the lowest quartile of the MDRS (range between one hundred thirty and one hundred thirty seven points). An individual analysis revealed that 3 of 12 patients showed a clinical relevant improvement in QoL whereas the group statistics did not reveal any significant improvement in QoL measures after STN-DBS compared to the BMT group. Since this failure to improve in QoL cannot be explained by a failure to improve in motor functions, stimulation settings and psychiatric scales after STN-DBS, the failure to improve in QoL in patients with a borderline global cognitive score might be specifically related to lower cognitive functioning.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease

Witt

Daniels

Krack

et al. 2011

Journal of the Neurological Sciences

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“…Both STN-and GPi-DBS can have non-motor side effects, especially affecting verbal fluency, cognition and mood (Kumar et al, 1999a, b;Dujardin et al, 2001;Schupbach et al, 2005;Smeding et al, 2005Smeding et al, , 2006Smeding et al, , 2011Castelli et al, 2006;De Gaspari et al, 2006, Merello et al, 2008. Verbal fluency and cognition problems are more often seen in old patients (Hariz et al, 2000;Saint-Cyr et al, 2000;Funkiewiez et al, 2004;Smeding et al, 2011), or in those with poor cognition or depression at baseline (De Gaspari et al, 2006).…”

Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

“…Verbal fluency and cognition problems are more often seen in old patients (Hariz et al, 2000;Saint-Cyr et al, 2000;Funkiewiez et al, 2004;Smeding et al, 2011), or in those with poor cognition or depression at baseline (De Gaspari et al, 2006). Specific cognition deficits include impairments of working memory (Saint-Cyr et al, 2000;Higginson et al, 2009;Okun et al, 2009), cognitive processing, visuo-spatial skills and setshifting (Saint-Cyr et al, 2000;Alegret et al, 2001), response inhibition (Witt et al, 2004), or the decoding of facial expressions (Dujardin et al, 2004;Schroeder et al, 2004;Biseul et al, 2005;Drapier et al, 2008).…”

Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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“…Most postoperative reports emerging from clinical studies measure standard cognitive, psychometric, and functional scales (Smeding et al 2011;Lewis et al 2015;Pham et al 2015;Schoenberg et al 2015). Most discussion of the postoperative changes following the implantation of brain devices such as DBS focuses on abnormal side effects caused by the intervention (e.g., hypersexuality, hypomania).…”

mentioning

confidence: 99%

I Miss Being Me: Phenomenological Effects of Deep Brain Stimulation

et al. 2017

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Predictors of cognitive and psychosocial outcome after STN DBS in Parkinson's Disease

Cited by 171 publications

References 39 publications

Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease

Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

I Miss Being Me: Phenomenological Effects of Deep Brain Stimulation

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