Objective: To determine if preoperative global cognitive score, Mattis Dementia Rating Scale 2nd Edition (DRS-2), predicts motor and quality of life (QoL) outcomes in patients with Parkinson’s disease (PD) or essential tremor (ET) undergoing deep brain stimulation (DBS) surgery.

Background: DBS is contraindicated in patients with dementia. For patients with borderline cognition clinical guidelines are less clear. DRS-2 scale is frequently used to evaluate global cognitive function, but it is unknown if it predicts clinical outcome and if a cut-off score should be used in clinical practice for DBS screening1,2.

Method: We used Emory’s clinical database to identify patients with PD or ET who underwent initial DBS surgery between 2008 and 2017. Analysis included all patients who had preoperative DRS-2 and motor rating scale and postoperative motor scale at approximately 12 months (off medications UPRDS or MDS-UPDRS part 3 for PD; FTM or TETRAS for ET). A subset of patients who had UPDRS part 2 or tremor activities of daily living (ADL) subscale available postoperatively were included in QoL analysis. Pearson correlation coefficient and t-test were used for statistical analysis.

Results: The analysis included 157 patients with PD (40% STN, 57% GPi, 3% VIM) and 74 patients with ET (all VIM). QoL was assessed in 63 PD and 69 ET patients. There was no difference in DRS-2 or motor improvement in patients who did not have follow up QoL scales compared to those who had. The average DRS-2 was 136±7 (mean±std, range 108-144) for PD and 134±8 (92-144) for ET. The time between surgery and follow up assessment was 11.7±4.5 months. In PD off medications motor score improved by 42±28% and in ET tremor score improved by 58±23%.  There was no significant correlation between DRS-2 score and motor score improvement in either disorder. In PD UPDRS part 2 score improved by 4±32% while in ET ADL score improved by 74±25%. Again, there was no correlation between DRS-2 score and QoL change.

Conclusion: Based on the initial analysis in our large clinical cohort, DRS-2 does not correlate with post-operative motor or quality of life change in patients with PD or ET. Additional variables that may influence clinical outcomes should be accounted for in future analyses, and comprehensive neuropsychological measures, as well as DRS-2 sub-scores explored as predictors.

References: 1. Witt K et al. J Neurol Sci. 2011 Nov 15;310(1-2):261-6. 2. Floden D et al. Mov Disord. 2015 Aug;30(9):1279-83.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-global-cognitive-score-on-motor-and-quality-of-life-outcomes-after-deep-brain-stimulation-in-patients-with-parkinsons-disease-or-essential-tremor/