Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease: Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy

Johannes C. Rothlind, Michele K. York, Kim Carlson, Ping Luo, William J. Marks, Frances M. Weaver, Matthew Stern, Kenneth Follett, Domenic Reda, K. F. Chairpersons, Dolores Ippolito, Gatana Stoner, Tammy Barnett, Ken Bukowski, Rosemarie De Nicolo, Kwan Hur, Joyce Jimenez, Jan Motyka, Theresa Simon, Bharat ThakkarRobert Woolson, Carol Fye, William Gagne, Crystal Harris, Jill Heemskerk, Claudia Moy, Paul Sheehy, Timothy O'Leary, Grant D. Huang, Louis Fiore, Robert Hall, Kevin Stroupe, Kim Burchiel, William Koller, Rajesh Pahwa, Oren Sagher, Roy Bakay, Rick Chappell, Robert Hart, Robert Holloway, George McCabe, Margaret Schenkman, Jamal Taha, Julia Buckelew, Marilyn Garin, Sharon Matzek, Donna Smith, Jeff Bronstein, John Duda, Penelope Hogarth, Stacy Horn, Eugene C. Lai, Ali Samii, Farah Atassi, Cecilia Bello, Lisette Bunting-Perry, Tina Conn, Alice Cugley, Nanette Eubank, Linda Fincher, Romay Franks, Tammy Harris, Mariann Haselman, Susan Heath, Miriam Hirsch, Virginia Janovsky, Elaine Lanier, Mary Lloyd, Susan Loehner, Susan O'Connor, Ligaya Ordonez, Heather Maccarone, Kelli Massey-Makhoul, Mary Matthews, Elizabeth Meyn, Keiko Mimura, Wes Morrow, Tammy Searles, Jamye Valotta, Usha Vasthare, Monica Volz, Constance Ward, Rebecca Warker, Heidi Watson, Pamela Willson, Mark Baron, Matthew Brodsky, Vincent Calabrese, Gordon Campbell, Amy Colcher, Emad Farag, Eva Henry, Jyh Gong Hou, Gail Kang, Galit Kleiner-Fisman, Jeff Kraakevik, John Nutt, Jill Ostrem, Aliya Sarwar, Indu Subramanian, Zeba Vanek, Gordon Baltuch, Antonio De Salles, Jorge Eller, Kathryn Holloway, Paul Larson, Richard Simpson, Philip Starr, William Carne, Tom Erikson, Jeffrey Kreutzer, Mario Mendez, Paul Moberg, John Ragland, Ronald Seel, Elizabeth Soety, Daniel Storzbach, Alexander Troster, Jurg Jaggi

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

Background: Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods: Neuropsychological functioning was assessed in patients with Parkinson's disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results: Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11%) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3%). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions: In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL.

Original languageEnglish (US)
Pages (from-to)622-629
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume86
Issue number6
DOIs
StatePublished - Jun 1 2015

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Surgery
  • Arts and Humanities (miscellaneous)
  • Medicine(all)

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    Rothlind, J. C., York, M. K., Carlson, K., Luo, P., Marks, W. J., Weaver, F. M., Stern, M., Follett, K., Reda, D., Chairpersons, K. F., Ippolito, D., Stoner, G., Barnett, T., Bukowski, K., De Nicolo, R., Hur, K., Jimenez, J., Motyka, J., Simon, T., ... Jaggi, J. (2015). Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease: Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy. Journal of Neurology, Neurosurgery and Psychiatry, 86(6), 622-629. https://doi.org/10.1136/jnnp-2014-308119