Patients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation: A Case-Control Study.
DBS
cognitive impairment
dementia
neurocognitive screening
outcomes
Journal
Movement disorders clinical practice
ISSN: 2330-1619
Titre abrégé: Mov Disord Clin Pract
Pays: United States
ID NLM: 101630279
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
30
09
2022
revised:
23
11
2022
accepted:
17
12
2022
pmc-release:
30
01
2024
entrez:
23
3
2023
pubmed:
24
3
2023
medline:
24
3
2023
Statut:
epublish
Résumé
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. 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. 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. 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. Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.
Sections du résumé
Background
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.
Identifiants
pubmed: 36949802
doi: 10.1002/mdc3.13660
pii: MDC313660
pmc: PMC10026300
doi:
Types de publication
Journal Article
Langues
eng
Pagination
382-391Subventions
Organisme : NIBIB NIH HHS
ID : P41 EB018783
Pays : United States
Organisme : NIH HHS
ID : P51 OD011132
Pays : United States
Organisme : NIMH NIH HHS
ID : R01 MH120194
Pays : United States
Informations de copyright
© 2023 International Parkinson and Movement Disorder Society.
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