Impact of mild cognitive impairment on outcome following deep brain stimulation surgery for Parkinson's disease

Hesham Abboud, Darlene Floden, Nicolas R. Thompson, Gencer Genc, Srivadee Oravivattanakul, Faisal Alsallom, Bengwei Swa, Cynthia Kubu, Mayur Pandya, Michal Gostkowski, Scott Cooper, Andre G. Machado, Hubert H. Fernandez

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32 Scopus citations

Abstract

Introduction: Unlike dementia, the effect of mild cognitive impairment (MCI) on outcomes after deep brain stimulation (DBS) in Parkinson's disease (PD) is less clear. We aimed to examine the effect of MCI on short- and long-term DBS outcomes. Methods: To study the effect of MCI type, cognitive domains (attention, language, visuospatial, memory, executive function), and Dementia Rating Scale (DRS) score on immediate postoperative outcomes (postoperative confusion, hospitalization days), PD patients who underwent DBS at our Center from 2006 to 2011 were analyzed. To determine cognitive predictors of intermediate (6-month) and long-term (1-year) post-operative outcomes, the changes in functional and quality-of-life (QOL) scores were analyzed in a smaller group with available preoperative health status measures. Results: We identified 130 patients [71% male, mean age: 63±9.1, mean PD duration: 10.7±5.1]. At preoperative assessment, 60% of patients had multiple-domain MCI, 21% had single-domain MCI, and 19% had normal cognition. MCI presence and type as well as DRS performance did not affect immediate outcomes. Attention impairment predicted longer postoperative hospitalization (P=0.0015) and showed a trend towards occurrence of postoperative confusion (P=0.089).For intermediate and long-term outcomes we identified 56 patients [73.2% male, mean age: 61.3±9.6, mean PD duration: 10.6±4.7]. Visuospatial impairment showed a trend towards less improvement in 6-month functional score (P=0.0652), and 1-year QOL score (P=0.0517). Conclusion: The presence of MCI did not affect DBS outcomes. However, the types of impaired domains were more detrimental. Detailed cognitive testing can help stratify low- and high-risk patients based on their pattern of cognitive dysfunction.

Original languageEnglish (US)
Pages (from-to)249-253
Number of pages5
JournalParkinsonism and Related Disorders
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2015

Bibliographical note

Funding Information:
D Floden, N Thompson, G Genc, S Oravivattanakul, F Alsallom, B Swa, C Kubu, M Gostkowski, and S Cooper have nothing to disclose. H Abboud received an educational grant from Teva Pharmaceuticals unrelated to this research, A Machado has distribution rights from ATI, Cardionomics and Enspire related to intellectual property. He is a consultant with Spinal Modulation and Functional Neuromodulation. His research is funded by National Institute of Health grants DOD006469A and R01 HD061363 . M Pandya receives fees of $5000 or more per year as a paid consultant, speaker or member of an advisory committee for the following companies: Lundbeck, Dr. Fernandez has received research support from Abbott, Acadia, Biotie Therapeutics, EMD-Serono, Huntington Study Group, Merck, Michael J. Fox Foundation, Merck, Movement Disorders Society, National Parkinson Foundation, NIH/NINDS, Novartis, Parkinson Study Group, Synosia, Teva, but has no owner interest in any pharmaceutical company. Dr. Fernandez has received honoraria from Advanced Health Media, Cleveland Clinic CME, Medical Communications Media, Movement Disorders Society, and Vindico Medical Education as a speaker in CME events. Dr. Fernandez has received honoraria from Ipsen, Merz Pharmaceuticals, Pfizer, Teva Neuroscience, and Zambon Pharmaceuticals, as a speaker and/or consultant. Dr. Fernandez has received royalty payments from Demos Publishing for serving as a book author/editor. The Cleveland Clinic has contracts with EMD Serono, Abbott and Merz pharmaceuticals for Dr. Fernandez’ role as a member of the Global Steering Committee for Safinamide and LCIG studies; and Head Principal Investigator for the Xeomin Registry Study. Dr. Fernandez also serves as the Chair of the Publication Committee for Xeomin Studies (Merz Pharmaceuticals); a member of the Publication Committee for Dysport studies (Ipsen Pharmaceuticals); and a consultant for Prostrakan/KyowaHakko, Britannia, Knopp and US WorldMeds but he does not receive any personal compensation for these roles. Dr. Fernandez has received a stipend from Movement Disorders Society for serving as Medical Editor of the MDS Web Site.

Keywords

  • Deep brain stimulation
  • Hospitalization
  • Mild cognitive impairment
  • Parkinson's disease

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