Objective: To evaluate if subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD) impacts caregiver burden (CB) and to determine which patient factors contribute to CB in a DBS-treated cohort.

Background: There is a high level of CB in PD, which can be associated with both motor and non-motor symptoms [1,2]. Although DBS is an effective treatment for motor symptoms of PD and improves quality of life, CB may not change [3]. Few longitudinal studies have evaluated CB after DBS and those available have been of small sample size and/or had follow up intervals less than 1-year [4-6]. It is possible that CB after DBS may initially worsen as stimulation settings are adjusted and then improve once stimulation is stabilized. More information is also needed on what factors, such as disease characteristics or neuropsychological performance, contribute to CB in PD patients treated with DBS.

Method: Data from 60 PD patients who underwent bilateral STN DBS and whose caregivers completed the caregiver burden inventory (CBI) pre-operatively and between 6 and 30 months after initial programming were analyzed. A subset of 34 patients had neuropsychological testing (NPT) at baseline and within 6 months of the follow-up CBI. Linear regression was used to assess which factors contributed to CBI within this subset. The relationship between change in CBI and change in patient symptoms was assessed via chi-square tests.

Results: CBI did not improve following DBS. In the NPT subset, change in CBI was associated with change in non-motor aspects of daily living (MDS-UPDRS I, p=0.02) but not with motor assessments. Caregiver rating of patient’s dysexecutive behavior before PD onset along with two neuropsychological measures of executive function significantly predicted baseline CBI, accounting for 50.6% of the variance (R2=.51, F(3,24)=8.20, p=0.001). Baseline CBI was not associated with patient age, gender, or motor dysfunction.

Conclusion: CB does not improve over the long-term (up to 30 months) after bilateral STN DBS for PD. CB in PD is associated with executive dysfunction, not motor impairment, which may explain why CB does not improve with DBS.

References: 1. Oguh O, Kwasny M, Carter J, Stell B, Simuni T. Caregiver strain in Parkinson’s disease: National Parkinson Foundation Quality Initiative Study. Parkinsonism & Related Disorders 2013; 19: 975-979. 2. Martinez-Martin P, Rodriguez-Blazquez C, João Forjaz M, et al. Neuropsychiatric symptoms and caregiver’s burden in Parkinson’s disease. Parkinsonism & Related Disorders 2015; 21: 629-634. 3. Oyama G, Okun MS, Schmidt P, et al. Deep brain stimulation may improve quality of life in people with Parkinson’s disease without affecting caregiver burden. Neuromodulation: Technology at the Neural Interface 2014; 17: 126-132. 4. Soileau MJ, Persad C, Taylor J, Patil PG, Chou KL. Caregiver burden in patients with Parkinson disease undergoing deep brain stimulation: an exploratory analysis. Journal of Parkinson’s Disease 2014; 4: 517-521. 5. Soulas T, Sultan S, Gurruchaga J-M, Palfi S, Fénelon F. Changes in quality of life, burden and mood among spouses of Parkinson’s disease patients receiving neurostimulation. Parkinsonism & Related Disorders 2012; 18: 602-605. 6. Mosley PE, Breakspear M, Coyne T, Silburn PA, Smith D. Caregiver burden and caregiver appraisal of psychiatric symptoms are not modulated by subthalamic deep brain stimulation for Parkinson’s disease. npj Parkinson Dis 2018; 4:12.

« Back to 2019 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/caregiver-burden-does-not-improve-in-the-long-term-after-deep-brain-stimulation-for-parkinson-disease/