Postoperative apathy can neutralise benefits in quality of life after subthalamic stimulation for Parkinson's disease.
BACKGROUND
Subthalamic nucleus deep brain stimulation (STN-DBS) improves motor symptoms of Parkinson's disease, leading to improvement in health-related quality of life (HRQoL). However, an excessive decrease in dopaminergic medication can lead to a withdrawal syndrome with apathy as the predominant feature. The present study aims to assess the impact of postoperative apathy on HRQoL.


METHODS
A cohort of 88 patients who underwent STN-DBS was divided into two groups, those who were apathetic at 1 year and those who were not, as measured by the Starkstein scale. HRQoL was assessed using the Parkinson's disease questionnaire 39 (PDQ-39) and was compared between the two groups. We also compared activities of daily living, motor improvement and motor complications (Unified Parkinson's Disease Rating Scale, UPDRS), depression and anxiety, as well as cognition and drug dosages. Baseline characteristics and postoperative complications were recorded.


RESULTS
One year after surgery, 27.1% of patients suffered from apathy. While motor improvement was significant and equivalent in both the apathy (-40.4% of UPDRS motor score) and non-apathy groups (-48.6%), the PDQ-39 score did not improve in the apathy group (-5.5%; p=0.464), whereas it improved significantly (-36.7%; p≤0.001) in the non-apathy group. Change in apathy scores correlated significantly with change in HRQoL scores (r=0.278, p=0.009). Depression and anxiety scores remained unchanged from baseline in the apathy group (p=0.409, p=0.075), while they improved significantly in patients without apathy (p=0.006, p≤0.001). A significant correlation was found between changes in apathy and depression (r=0.594, p≤0.001).


CONCLUSIONS
The development of apathy after STN-DBS can cancel out the benefits of motor improvement in terms of HRQoL. Systematic evaluation and management of apathy occurring after subthalamic stimulation appears mandatory.
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France CINAC-HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.
Raul
R
Martinez-Fernandez
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Pierre
P
Pelissier
Centre d'Investigation Clinique, CHU de Grenoble, Univesité Joseph Fourier, Grenoble, France Direction de la recherche clinique, Département scientifique, CHU Grenoble, Grenoble, France.
Jean-Louis
JL
Quesada
Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France.
Hélène
H
Klinger
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Eugénie
http://orcid.org/0000-0002-4719-5090
E
Lhommée
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Emmanuelle
E
Schmitt
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Valerie
V
Fraix
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France Deparment of Neurosurgery, CHU de Grenoble, Grenoble, France.
Stephan
S
Chabardes
Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France.
Patrick
P
Mertens
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Anna
A
Castrioto
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Andrea
A
Kistner
Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France.
Emmanuel
E
Broussolle
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Pierre
P
Pollak
Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France.
Stéphane
S
Thobois
Movement Disorders Unit, Department of Psychiatry and Neurology, CHU de Grenoble, Université de Grenoble Alpes, Grenoble, France INSERM, U386, Grenoble Institut de Neurosciences, Grenoble, France.
Paul
P
Krack
D000203:Activities of Daily Living; D001007:Anxiety / Q000523:psychology; D057565:Apathy; D016022:Case-Control Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000523:psychology* / Q000601:surgery / Q000628:therapy; D011183:Postoperative Complications / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012189:Retrospective Studies; D020531:Subthalamic Nucleus / Q000502:physiology*; D016896:Treatment Outcome
NEUROSURGERY; PARKINSON'S DISEASE; QUALITY OF LIFE