Objective: This is a long-term follow-up study of a group of patients with levo-dopa responsive fluctuating Parkinson’s disease (PD), with focus on the short- and long-term effects of subthalamic deep brain stimulation (STN-DBS) on cognition and mood.

Background: Cognitive impairment and depression are well-described and common findings in patients with advanced PD. However, documentation of the long-term effects of STN-DBS on cognition and mood is sparse.

Method: In a retrospective manner, we analyzed neuropsychological data of 81 patients before STN-DBS surgery, with follow-up data of 37 patients 3 months after surgery and 68 patients 1 year after surgery. In a long-term follow-up examination 8-15 years after surgery 29 of these patients were eligible for neuropsychological re-examination.

Results: Eighty-one patients were neuropsychologically evaluated before surgery, 38.3 % females, 61.7 % males. The mean age at surgery was 60.1 years and the mean disease duration was 13.0 years. Mild cognitive impairment (MCI) was identified in 50.6% of the patients before surgery with a mean disease duration of 14.2 years. Clinically diagnosed dementia before death or before long-term follow-up was not correlated to pre-operative MCI (OR 0.7, 95% CI 0.3-1.8, p=0.480) but was positively correlated with disease duration at the time of surgery (p=0.005). Verbal fluency was significantly impaired 3 months after surgery and global cognition, attention and verbal fluency were significantly impaired 1 year after surgery compared to the pre-surgical state. Various domains were impaired at long-term follow-up, including global cognition, attention, memory, language and executive functioning. The depression rate before surgery was 33.8% and remained unaffected 3 months and 1 year after surgery, however the depression rate was significantly higher at long-term follow-up (64.3%, p=0.002). Depression before surgery was correlated to the presence of MCI. At long-term follow-up depression was correlated to dementia.

Conclusion: The influence on cognition and mood was described in a short- and long-term follow-up study up to 15 years after STN-DBS surgery in PD patients. Disease duration, but not pre-operative MCI, was a risk factor for the development of dementia. Global cognition was relatively spared, but changes in verbal fluency was described both in a short- and long-term follow-up.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mild-cognitive-impairment-does-not-predict-development-of-dementia-up-to-15-years-after-subthalamic-deep-brain-stimulation-in-parkinsons-disease/