Category: Parkinson's Disease: Surgical Therapy
Objective: To identify preoperative clinical and imaging predictors of post-deep brain stimulation (DBS) dementia in Parkinson’s disease (PD) patients, focusing on multiple potential risk factors including cardiac MIBG delayed heart-to-mediastinum (H/M) ratio.
Background: DBS effectively manages motor symptoms in PD; however, concerns persist regarding potential cognitive deterioration in certain patients. Establishing reliable preoperative predictors of post-DBS dementia is essential for optimizing patient selection and risk stratification.
Method: This retrospective cohort study evaluated 50 PD patients who underwent bilateral DBS with one-year postoperative follow-up. Patients were stratified based on post-surgical dementia development. Preoperative variables included demographic factors (sex, age at surgery), clinical characteristics (disease duration, LEDD, RBD status), and neuroimaging markers (cardiac MIBG delayed H/M ratio).
Results: Nine patients (18%) developed dementia within one year post-DBS. The dementia group exhibited significantly higher age at surgery (median: 68 vs. 64 years, p = 0.027) and markedly lower MIBG delayed H/M ratio (median: 1.11 vs. 1.43, p = 0.003). No significant between-group differences were observed in disease duration, sex distribution, or RBD prevalence. Multivariate logistic regression identified MIBG delayed H/M ratio (p = 0.002) and preoperative LEDD (p = 0.007) as independent predictors of dementia development.
Conclusion: Lower MIBG delayed H/M ratio and higher preoperative LEDD independently predicted post-DBS dementia development in PD patients, with advanced age at surgery also associated with increased risk. These findings highlight the importance of including cardiac sympathetic denervation assessment and levodopa burden evaluation in preoperative cognitive risk assessment protocols. Implementation of these predictive markers may enhance patient selection, improve preoperative counseling, and potentially optimize postoperative cognitive outcomes in PD patients undergoing DBS.
To cite this abstract in AMA style:
DG. Park, YS. Kim, MS. Kim, JH. Yoon. Preoperative Predictors of Post-DBS Cognitive Decline: Cardiac MIBG Imaging and Levodopa Burden as Risk Factors for Dementia in Parkinson’s Disease [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/preoperative-predictors-of-post-dbs-cognitive-decline-cardiac-mibg-imaging-and-levodopa-burden-as-risk-factors-for-dementia-in-parkinsons-disease/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/preoperative-predictors-of-post-dbs-cognitive-decline-cardiac-mibg-imaging-and-levodopa-burden-as-risk-factors-for-dementia-in-parkinsons-disease/