title: Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation.
abstract: Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson's disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25-30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery.
authors.affiliation: Department of Neurology, The Parkinson's Disease and Movement Disorders Center, Baylor College of Medicine, 6501 Fannin, NB302 Houston, TX 77030, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Williams
authors.forename: Gladys Marina
authors.initials: GM
authors.lastname: Arzola
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Strutt
authors.forename: Richard
authors.initials: R
authors.lastname: Simpson
authors.forename: Joseph
authors.initials: J
authors.lastname: Jankovic
authors.forename: Michele K
authors.initials: MK
authors.lastname: York
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology* / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D007802:Language; D008137:Longitudinal Studies; D008297:Male; D008568:Memory / Q000502:physiology; D008606:Mental Processes / Q000502:physiology; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications* / Q000628:therapy; D020531:Subthalamic Nucleus / Q000502:physiology*; D014796:Visual Perception