Objective: The aim of the present study was to elucidate the properties of drawing ability in Parkinson’s disease (PD) patients after bilateral subthalamic nucleus deep brain stimulation (STN DBS) using perfusion SPECT.

Background: Subthalamic nucleus deep brain stimulation is an established therapy for motor symptoms in advanced Parkinson’s disease patients. However, a postoperative decline in cognition, including executive function has been reported. A few artistic ability in PD has been reported, there has been no substantial evidence for drawing ability in PD patients.for drawing ability in PD patients.

Methods: Twenty-one PD patients conducted bilateral STN DBS and Western aphasia battery drawing subcategory and perfusion (123I-IMP) SPECT was both evaluated before and 3 to 6 months after operation. In the parametric image analysis, the statistical threshold was set at P < 0.001 uncorrected, with cluster sizes over 100 voxels.

Results: Postoperatively, 11 PD patients (52.4%) showed a decline in drawing subcategory, despite improvement in off-state motor symptoms (p < 0.003) and preservation in general cognition, evaluated by Mini-Mental State Examination (p = 0.37). There was no difference in age, gender, disease duration, motor improvement, medication dosage, or stimulator conditions between the patient groups with and without decline in drawing. The PD patients which decline in drawing score showed a reduction in Frontal Assessment Battery score (p < 0.01). PD Patients whose drawing ability declined showed reduced perfusion in right prefrontal (Brodmann’s area 10) compared with those without a decline. The drawing subcategory score positively correlated with regional blood flow in the right prefrontal cortex (Brodmann’s area 8, 9 and 44) after surgery, which contrasts with the result before surgery where occipital association area (Brodmann’s area 18 and 19) showed positively correlated region.

Conclusions: Some PD patients exhibit a decline of drawing ability after bilateral STN DBS which is attributable to executive dysfunction explained by non-dominant frontal dysfunction demonstrated by neuropsychological test and perfusion neuroimaging techniques.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/decline-in-drawing-ability-associated-with-frontal-dysfunction-after-subthalamic-nucleus-deep-brain-stimulation-in-parkinsons-disease/