Objective: To evaluate the effect of GP and STN DBS upon anticholinergic medication burden in patients with PD.

Background: Medications with anticholinergic effects are commonly used in the treatment of motor and nonmotor PD symptoms. Prior studies have shown that high anticholinergic burden is associated with adverse events in PD, including fractures, falls, delirium, hospitalizations, and progression of dementia^1-3. Though DBS allows for down-titration of PD-related medications, the impact of DBS upon anticholinergic burden has never been studied. We hypothesized that DBS lowers anticholinergic burden in patients with PD.

Method: A retrospective chart review was conducted for 242 patients with PD who underwent bilateral STN or GP DBS at Oregon Health and Science University from January 2010 through January 2020. Demographic information, UPDRS part III scores, and medication lists at baseline and 6 months after surgery were extracted and analyzed. The cumulative burden of anticholinergic medications at each visit was calculated using the Anticholinergic Risk Scale (ARS), a tool that estimates individuals’ risk of anticholinergic adverse effects¹. We utilized Wilcoxon signed-rank tests to detect changes in patients’ ARS scores between baseline and 6 months after surgery and independent sample t-tests to test for group differences based on DBS target.

Results: Patients who underwent GP or STN DBS did not differ significantly in terms of age, symptom duration, Hoehn and Yahr stage, or UPDRS part III ON/OFF medication scores (pre- and post-op) (Table 1). ARS scores were significantly lowered for all patients 6 months after surgery, compared to baseline (z=6.58, p<0.0001), and for both targets: GP (n=173; z=5.29, p<0.0001) and STN (n=69; z=3.98, p=0.0001). Change in ARS scores was driven by down-titration of PD medications (z=9.35, p<0.0001), rather than changes in pain, psychiatric, and/or urinary medications with anticholinergic effects (p=0.08; p=0.09; p=0.99). There was no significant difference in change in ARS scores between targets (t=-0.03, p=0.98).

Conclusion: DBS of either the GP or STN lowers anticholinergic burden in patients with Parkinson’s disease. Future prospective studies are needed to evaluate the impact of changes in anticholinergic burden upon cognition of patients undergoing DBS.

References: [1] Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The Anticholinergic Risk Scale and Anticholinergic Adverse Effects in Older Persons. Arch Intern Med. 2008;168(5):508–513. doi:10.1001/archinternmed.2007.106)
[2] Crispo, J. A., Willis, A. W., Thibault, D. P., Fortin, Y., Hays, H. D., McNair, D. S., Bjerre, L. M., Kohen, D. E., Perez-Lloret, S., Mattison, D. R., & Krewski, D. (2016). Associations between Anticholinergic Burden and Adverse Health Outcomes in Parkinson Disease. PloS one, 11(3), e0150621. https://doi.org/10.1371/journal.pone.0150621
[3] Sheu JJ, Tsai MT, Erickson SR, Wu CH. Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson’s Disease. Pharmacotherapy. 2019 Aug;39(8):798-808. doi: 10.1002/phar.2305. Epub 2019 Jul 17. PMID: 31251824.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/changes-in-anticholinergic-burden-in-patients-with-parkinsons-disease-pd-after-bilateral-deep-brain-stimulation-dbs-of-the-globus-pallidus-gp-and-subthalamic-nucleus-stn/