Objective: To evaluate the effect of baseline cognitive status of Parkinson’s disease (PD) on the outcome after deep brain stimulation (DBS) surgery.

Background: Advanced dementia is a contraindication for DBS in PD patients because patients need to be cognitively intact to participate awake surgery and to manage the device properly. Although patients at the early stage of PD dementia (PDD) undergo DBS expecting improvement of motor symptoms before the dementia become overt, little is known about the effect of baseline cognitive status on the outcome of DBS for PD.

Method: We retrospectively reviewed patients who underwent DBS for PD from March 2002 to December 2015. Baseline cognitive status was classified into normal cognition (PD-NC), mild cognitive impairment (PD-MCI), and early stage of dementia (PDD) according to the Movement Disorder Society criteria. Patients who turned out to be atypical Parkinsonism later and those who died or remained severely disabled due to operative complication were excluded. We used step-wise Cox regression models to calculate hazard ratios for shorter survival, nursing home admission and conversion to Hoehn & Yahr stage 5 (H&Y 5) according to baseline cognitive status adjusted for age at operation, sex, disease duration, and surgery type (subthalamic nucleus or globus pallidus interna).

Results: A total of 154 PD patients (42 PD-NC, 101 PD-MCI, 11 early PDD) who underwent DBS were included. We recorded 43 deaths. Survival rate was not associated with baseline cognitive status. 32 patients were admitted to nursing home. Early PDD patients higher nursing home admission rate compared to PD-NC (hazard ratio (HR) = 14.0; 95% confidence interval (CI) = 3.6–55.1; P<0.001) and compared to PD-MCI (HR=10.8; 95% CI= 3.7-32.2; P<0.001). Conversion to H&Y 5 was observed in 31 patients. Early PDD patients had higher conversion rate compared to PD-NC (HR=24.8; 95% CI= 5.5-110.7; P<0.001) and compared to PD-MCI (HR=6.5; 95% CI=2.4-19.2, P<0.001).

Conclusion: PDD state at the timing of DBS did not affect survival, but PDD patients had much higher rate of nursing home administration and becoming bed-ridden status after DBS surgery. Careful interpretation of pre-operative neuropsychiatric evaluation and exhaustive discussion with the caregivers are warranted for the patients considering DBS at PDD state, even at the early stage.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effect-of-baseline-cognitive-status-of-parkinsons-disease-on-the-outcome-after-deep-brain-stimulation-surgery/