Objective: In this study we examined frequency of cognitive and psychiatric disorders identified during neuropsychological evaluation for Deep Brain Stimulation (DBS) in patients with Essential Tremor (ET). Specifically, rates of dementia, Mild Cognitive Impairment (MCI), common psychiatric disorders, and use of concomitant psychiatric medications (antidepressants, anxiolytics, and antipsychotics) were compared to DBS candidates with Parkinsons disease (PD).

Background: DBS can be effective in addressing motor symptoms PD and ET. Most DBS centers require formal neuropsychological evaluation of PD surgical candidates to assess for cognitive and psychiatric disturbances, as these are common complications that bear on safety and risk. However, clinical necessity of neuropsychological evaluation in ET has been debated.  An argument to eliminate pre-DBS neuropsychological evaluation could be supported if neuropsychiatric disturbances were relatively infrequent in ET compared to PD candidates.

Method: This investigation was a retrospective chart review of pre-DBS neuropsychological evaluations for all patients seen in our clinic from 2010 through 2023 with approval by our Institutional Review Board. Cognitive diagnosis followed Movement Disorders Society Task Force criteria. All DBS candidates underwent neuropsychological evaluation.  Patients with established ET and PD diagnoses were included; other tremor types were excluded. In recording psychiatric medications use, those prescribed for tremor (ex., topiramate) or dream enactment in PD (ex., clonazepam) were not considered.

Results: A total of 323 patients (ET=98, PD=225) were reviewed. Demographic and clinical features are provided in Table 1. Dementia diagnosis was infrequent in ET (1%) and PD (5%). MCI diagnosis was common in ET (50%), and not significantly different from PD (57%). Psychiatric disorders were present in 39% of ET patients, similar to PD (47%). Examined separately, frequency of mood, anxiety, adjustment, and alcohol use disorders were not significantly different between groups. Frequency of antidepressant, anxiolytic, and antipsychotic medication therapy were similar as well.

Conclusion: In our clinic, MCI and psychiatric disorders were common in ET patients seeking DBS, with similar prevalence as PD candidates. To the extent that neuropsychological evaluation is needed to assess DBS candidacy in PD, these findings support need in ET candidates as well.

Table 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/is-neuropsychological-evaluation-needed-to-assess-dbs-candidacy-in-essential-tremor/