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

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in Parkinson'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.

Witt K ，Daniels C ，Krack P ，Volkmann J ，Pinsker MO ，Kloss M ，Tronnier V ，Schnitzler A ，Wojtecki L ，Bötzel K ，Danek A ，Hilker R ，Sturm V ，Kupsch A ，Karner E ，Deuschl G ... -  《-》

Is improvement in the quality of life after subthalamic nucleus stimulation in Parkinson's disease predictable?

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in PD. However, QoL fails to improve in a relevant proportion of patients. We studied clinical baseline and progression parameters associated with improvement in QoL after DBS. Data from a German randomized, controlled study comparing DBS (60 patients) with best medical treatment (59 patients) were analyzed. Changes in patients' QoL were assessed using the Parkinson's Disease Questionnaire (PDQ-39) at baseline and at the 6-month follow-up. For the STN-DBS patients, the changes in PDQ-39 were correlated with predefined clinical preoperative and progression parameters. Scores for QoL improved after STN-DBS for 57% of the patients, and for 43% patients, they did not improve. Patients with improvement in QoL showed significantly higher cumulative daily "off" time. Changes in the PDQ-39 showed a significant positive correlation with the cumulative daily off time at baseline. Logistic regression analysis revealed that 1 additional hour off time at baseline increases the odds for improvement on PDQ-39 by a factor of 1.33 (odds ratio). In the postoperative course, changes in the PDQ-39 significantly correlated with the reduction of cumulative daily off time, an improvement on the UPDRS (UPDRS III off), and positive mood changes. Among the baseline parameters, the cumulative daily off time is the strongest predictor for improvement in disease-related QoL after DBS. Improvement in QoL after STN-DBS is also correlated with changes in motor functions and changes in depression and anxiety.

Daniels C ，Krack P ，Volkmann J ，Raethjen J ，Pinsker MO ，Kloss M ，Tronnier V ，Schnitzler A ，Wojtecki L ，Bötzel K ，Danek A ，Hilker R ，Sturm V ，Kupsch A ，Karner E ，Deuschl G ，Witt K ... -  《-》

Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease.

Daniels C ，Krack P ，Volkmann J ，Pinsker MO ，Krause M ，Tronnier V ，Kloss M ，Schnitzler A ，Wojtecki L ，Bötzel K ，Danek A ，Hilker R ，Sturm V ，Kupsch A ，Karner E ，Deuschl G ，Witt K ... -  《-》

Neuropsychological and psychiatric changes after deep brain stimulation for Parkinson's disease: a randomised, multicentre study.

Witt K ，Daniels C ，Reiff J ，Krack P ，Volkmann J ，Pinsker MO ，Krause M ，Tronnier V ，Kloss M ，Schnitzler A ，Wojtecki L ，Bötzel K ，Danek A ，Hilker R ，Sturm V ，Kupsch A ，Karner E ，Deuschl G ... -  《LANCET NEUROLOGY》

Deep brain stimulation and cognitive functions in Parkinson's disease: A three-year controlled study.

There is debate over the cognitive and behavioral effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in advanced Parkinson's disease (PD). To evaluate these effects, we performed a prospective, naturalistic controlled, 3-year follow-up study. A total of 65 PD patients were enrolled, of whom 32 underwent STN-DBS (PD-DBS) and 33, even though eligible for this treatment, declined surgery and chose other therapeutic procedures (PD-control). Motor and neuropsychological functions were assessed in all the subjects at baseline (T0) and 36 months (T36). The PD-DBS patients were also evaluated at 1, 6, 12, and 24 months after surgery (T1, T6, T12, and T24). At T1, compared with T0, the PD-DBS patients recorded worse logical executive function task and verbal fluency (FAS) scores, whereas their performance of memory tasks remained stable. At T12, their cognitive profile had returned within the pre-DBS range, thereafter remaining stable until T36. FAS scores at T36 were significantly worse in the PD-DBS compared with the PD-control patients. This is the first long-term naturalistic controlled study of cognitive functions in PD patients submitted to STN-DBS. Our results confirm previous reports of a worsening of verbal fluency after DBS, but show that STN-DBS seems to be relatively safe from a cognitive standpoint, as the short-term worsening of frontal-executive functions was found to be transient.

Zangaglia R ，Pacchetti C ，Pasotti C ，Mancini F ，Servello D ，Sinforiani E ，Cristina S ，Sassi M ，Nappi G ... -  《-》