title: Subthalamic deep brain stimulation: clinical and neuropsychological outcomes in mild cognitive impaired parkinsonian patients.
abstract: This observational study reports the long-term follow-up of 184 Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS), retrospectively analyzing the outcomes of subjects with pre-surgical mild cognitive impairment (MCI) compared to those of patients with normal cognition. Patients were divided into PD-MCI or normal cognition groups at baseline, and then compared after 1, 3, 5 and >5 years of follow-up. Subjects assessed by outpatient clinical follow-up evaluation, not performing a complete clinical and neuropsychological follow-up assessment, were separately considered and rated according to their functional autonomy in daily living activities. The MCI prevalence at baseline was 23 %, increasing to 34 % at 1 year and over 40 % after 3 years. Dementia progressively affected more than 30 % of subjects after a median time of 6 years in the PD-MCI group and 11 years in the normal cognition group (p: 0.028). The mortality risk was slightly higher in PD-MCI patients. Outpatient clinical evaluations showed a progressive increase of subjects completely dependent in the activities of daily living, which ranged from the 11 % at 3 years to 23 % at 5 years and 31 % at >5 years. MCI can be frequently observed in PD patients, possibly influencing the outcome of surgical therapy. Our findings confirm the sustained long-lasting efficacy of STN-DBS on motor functions in both PD-MCI and normal cognition subjects. PD-MCI patients showed a more precocious cognitive impairment, as expected by natural history studies, but no case of dementia was observed early after surgery.
authors: Department of Neuroscience, University of Turin, Via Cherasco 15, 10124, Turin, Italy, aristidemerola@hotmail.com.
authors: Aristide
authors: A
authors: Merola
authors: Laura
authors: L
authors: Rizzi
authors: Carlo Alberto
authors: CA
authors: Artusi
authors: Maurizio
authors: M
authors: Zibetti
authors: Mario Giorgio
authors: MG
authors: Rizzone
authors: Alberto
authors: A
authors: Romagnolo
authors: Andrea
authors: A
authors: Bernardini
authors: Michele
authors: M
authors: Lanotte
authors: Leonardo
authors: L
authors: Lopiano
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D003071:Cognition; D060825:Cognitive Dysfunction / Q000523:psychology / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods*; D003704:Dementia / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome