Journal of Neurology

, Volume 261, Issue 6, pp 1090–1096

Long-term cognitive outcome of bilateral subthalamic deep brain stimulation in Parkinson’s disease

  • Han-Joon Kim
  • Beom S. Jeon
  • Sun Ha Paek
  • Kyoung-Min Lee
  • Ji-Young Kim
  • Jee-Young Lee
  • Hee Jin Kim
  • Ji Young Yun
  • Young Eun Kim
  • Hui-Jun Yang
  • Gwanhee Ehm
Original Communication

DOI: 10.1007/s00415-014-7321-z

Cite this article as:
Kim, HJ., Jeon, B.S., Paek, S.H. et al. J Neurol (2014) 261: 1090. doi:10.1007/s00415-014-7321-z

Abstract

The effect of subthalamic deep brain stimulation (STN DBS) on cognition in Parkinson’s disease (PD) remains controversial, and it is unclear which factors are related to cognitive decline and dementia after STN DBS, especially over the long term. To this end, we analyzed the cognitive outcome of 103 non-demented patients with PD who were followed-up for at least 12 months after bilateral STN DBS surgery. Preoperatively, the patients were evaluated with the Unified Parkinson's Disease Rating Scale and neuropsychological tests. The rate of global cognitive decline and the incidence of dementia during follow-up for up to 7 years (mean 42.4 ± 24.5 months) were calculated, and preoperative clinical and neuropsychological factors associated with postoperative global cognitive decline or dementia were analyzed. The prevalence of mild cognitive impairment (MCI) and its relation to later cognitive decline or dementia were also evaluated. The annual decline in the mini–mental state examination score was 0.4 ± 1.7 with impaired attention and executive function and a higher levodopa equivalent dose at baseline being the predictors of a faster global cognitive decline after STN DBS. Dementia developed in 13 patients with an incidence rate of 35.7 per 1,000 person-years. Impaired executive function at baseline predicted dementia. At baseline, 63.1 % of the patients had PD-MCI, and these patients were more likely to develop dementia than those without PD-MCI. This study showed that dysfunctions in the frontostriatal circuitry at baseline were associated with a risk of subsequent global cognitive decline and dementia in patients with PD who underwent STN DBS. In addition, preoperative PD-MCI was a risk factor for dementia after STN DBS.

Keywords

Parkinson’s diseaseDBSDementiaMild cognitive impairment

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Han-Joon Kim
    • 1
  • Beom S. Jeon
    • 1
  • Sun Ha Paek
    • 2
  • Kyoung-Min Lee
    • 1
  • Ji-Young Kim
    • 3
  • Jee-Young Lee
    • 4
  • Hee Jin Kim
    • 5
  • Ji Young Yun
    • 6
  • Young Eun Kim
    • 7
  • Hui-Jun Yang
    • 8
  • Gwanhee Ehm
    • 1
  1. 1.Department of Neurology and Movement Disorder Center, Parkinson Study Group, and Neuroscience Research Institute, College of MedicineSeoul National UniversitySeoulKorea
  2. 2.Department of Neurosurgery, Movement Disorder Center, and Neuroscience Research Institute, College of MedicineSeoul National University HospitalSeoulKorea
  3. 3.Department of NeurologyInje University Seoul Paik HospitalSeoulKorea
  4. 4.Department of Neurology, College of MedicineSeoul National University, Metropolitan Boramae HospitalSeoulKorea
  5. 5.Department of NeurologyKonkuk University Medical CenterSeoulKorea
  6. 6.Department of NeurologyEwha Womans University Mokdong HospitalSeoulKorea
  7. 7.Department of NeurologySeoul National University Bundang HospitalSongnamKorea
  8. 8.Department of NeurologyUlsan University HospitalUlsanKorea