TY - JOUR
T1 - Patients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation
T2 - A Case-Control Study
AU - Block, Cady K.
AU - Patel, Margi
AU - Risk, Benjamin B.
AU - Staikova, Ekaterina
AU - Loring, David
AU - Esper, Christine D.
AU - Scorr, Laura
AU - Higginbotham, Lenora
AU - Aia, Pratibha
AU - DeLong, Mahlon R.
AU - Wichmann, Thomas
AU - Factor, Stewart A.
AU - Au Yong, Nicholas
AU - Willie, Jon T.
AU - Boulis, Nicholas M.
AU - Gross, Robert E.
AU - Buetefisch, Cathrin
AU - Miocinovic, Svjetlana
N1 - Funding Information:
For research covered in this article, the work was supported by the American Parkinson Disease Association grant and funding from the NIH (P50 NS123103, P51 OD011132). Funding Sources and Conflicts of Interest:
Publisher Copyright:
© 2023 International Parkinson and Movement Disorder Society.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Deep brain stimulation (DBS) for Parkinson's disease (PD) is generally contraindicated in persons with dementia but it is frequently performed in people with mild cognitive impairment or normal cognition, and current clinical guidelines are primarily based on these cohorts. Objectives: To determine if moderately cognitive impaired individuals including those with mild dementia could meaningfully benefit from DBS in terms of motor and non-motor outcomes. Methods: In this retrospective case-control study, we identified a cohort of 40 patients with PD who exhibited moderate (two or more standard deviations below normative scores) cognitive impairment (CI) during presurgical workup and compared their 1-year clinical outcomes to a cohort of 40 matched patients with normal cognition (NC). The surgery targeted subthalamus, pallidus or motor thalamus, in a unilateral, bilateral or staged approach. Results: At preoperative baseline, the CI cohort had higher Unified Parkinson's Disease Rating Scale (UPDRS) subscores, but similar levodopa responsiveness compared to the NC cohort. The NC and CI cohorts demonstrated comparable degrees of postoperative improvement in the OFF-medication motor scores, motor fluctuations, and medication reduction. There was no difference in adverse event rates between the two cohorts. Outcomes in the CI cohort did not depend on the target, surgical staging, or impaired cognitive domain. Conclusions: Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.
AB - Background: Deep brain stimulation (DBS) for Parkinson's disease (PD) is generally contraindicated in persons with dementia but it is frequently performed in people with mild cognitive impairment or normal cognition, and current clinical guidelines are primarily based on these cohorts. Objectives: To determine if moderately cognitive impaired individuals including those with mild dementia could meaningfully benefit from DBS in terms of motor and non-motor outcomes. Methods: In this retrospective case-control study, we identified a cohort of 40 patients with PD who exhibited moderate (two or more standard deviations below normative scores) cognitive impairment (CI) during presurgical workup and compared their 1-year clinical outcomes to a cohort of 40 matched patients with normal cognition (NC). The surgery targeted subthalamus, pallidus or motor thalamus, in a unilateral, bilateral or staged approach. Results: At preoperative baseline, the CI cohort had higher Unified Parkinson's Disease Rating Scale (UPDRS) subscores, but similar levodopa responsiveness compared to the NC cohort. The NC and CI cohorts demonstrated comparable degrees of postoperative improvement in the OFF-medication motor scores, motor fluctuations, and medication reduction. There was no difference in adverse event rates between the two cohorts. Outcomes in the CI cohort did not depend on the target, surgical staging, or impaired cognitive domain. Conclusions: Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.
KW - DBS
KW - cognitive impairment
KW - dementia
KW - neurocognitive screening
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=85147389019&partnerID=8YFLogxK
U2 - 10.1002/mdc3.13660
DO - 10.1002/mdc3.13660
M3 - Article
C2 - 36949802
AN - SCOPUS:85147389019
SN - 2330-1619
VL - 10
SP - 382
EP - 391
JO - Movement Disorders Clinical Practice
JF - Movement Disorders Clinical Practice
IS - 3
ER -