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

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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.

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Acknowledgments

This study was supported by grants from the Korea Health technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A101273), the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea. (HI12C0205), and the Korea Institute of Planning & Evaluation for Technology in Food, Agriculture, Forestry, and Fisheries, Republic of Korea (311011-05-1-SB010).

Conflicts of interest

Dr. H. J. Kim reports no disclosures. Dr. B. S. Jeon has received funding for travel from Medtronics. Dr. S. H. Paek, Dr. K. M. Lee, Dr. J. Y. Kim, Dr. J. Y. Lee, Dr. H. J. Kim, Dr. J. Y. Yun, Dr. Y. E. Kim, Dr. H. J. Yang and Dr. G. Ehm reports no disclosures.

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Authors and Affiliations

  1. Department of Neurology and Movement Disorder Center, Parkinson Study Group, and Neuroscience Research Institute, College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Han-Joon Kim, Beom S. Jeon, Kyoung-Min Lee & Gwanhee Ehm

  2. Department of Neurosurgery, Movement Disorder Center, and Neuroscience Research Institute, College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea

    Sun Ha Paek

  3. Department of Neurology, Inje University Seoul Paik Hospital, Seoul, Korea

    Ji-Young Kim

  4. Department of Neurology, College of Medicine, Seoul National University, Metropolitan Boramae Hospital, Seoul, Korea

    Jee-Young Lee

  5. Department of Neurology, Konkuk University Medical Center, Seoul, Korea

    Hee Jin Kim

  6. Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea

    Ji Young Yun

  7. Department of Neurology, Seoul National University Bundang Hospital, Songnam, Korea

    Young Eun Kim

  8. Department of Neurology, Ulsan University Hospital, Ulsan, Korea

    Hui-Jun Yang

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  1. Han-Joon Kim
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Correspondence to Beom S. Jeon or Sun Ha Paek.

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Kim, HJ., Jeon, B.S., Paek, S.H. et al. Long-term cognitive outcome of bilateral subthalamic deep brain stimulation in Parkinson’s disease. J Neurol 261, 1090–1096 (2014). https://doi.org/10.1007/s00415-014-7321-z

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  • DOI: https://doi.org/10.1007/s00415-014-7321-z

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