Objective: To identify preoperative microstructural markers that are associated with postoperative changes in cognition.

Background: Subthalamic deep brain stimulation (STN-DBS) represents an established therapeutic intervention for advanced Parkinson’s disease (PD), alleviating motor and non-motor symptoms. However, there are considerable interindividual differences in postoperative cognitive outcome: some patients experience preserved cognitive functions, while others show cognitive decline. The mechanisms underlying this variability remain poorly understood, emphasizing the need to predict postoperative cognition outcomes.

Method: This prospective open-label study aimed to identify microstructural markers related to postoperative cognitive changes after STN-DBS. Forty patients underwent diffusion MRI and clinical assessments preoperatively and six months postoperatively. A whole-brain voxel-wise analysis utilizing diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) was conducted to investigate associations between microstructural metrics and changes in Montreal Cognitive Assessment (MoCA) scores.

Results: Compromised microstructure in white matter tracts, including left superior longitudinal fasciculus, bilateral corticospinal tract, and bilateral inferior fronto-occipital fasciculus, was associated with worse postoperative MoCA outcomes. Similarly, compromised gray matter microstructure in the bilateral occipital cortex, bilateral cingulate gyrus, and bilateral precuneus was associated with postoperative cognitive decline.

Conclusion: These findings show that diffusion MRI could support preoperative patient counselling by identifying patients who are likely to experience postoperative cognitive decline.

« Back to 2026 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/microstructure-predicts-cognition-after-neurostimulation-in-parkinsons-disease/