Objective: To identify preoperative cognitive performance measures associated with patient- and/or caregiver-reported cognitive decline following deep brain stimulation (DBS) surgery for movement disorders.

Background: Patients undergoing DBS for movement disorders can experience minor changes in cognition following surgery but multi-domain cognitive impairment is rare. Neuropsychological predictors of patient-reported postoperative cognitive decline are needed.

Methods: We surveyed 60 movement disorders patients (49 Parkinson’s disease (PD), 10 essential tremor (ET), 1 dystonia) and 52 caregivers (43 PD, 7 ET, 2 dystonia) regarding subjective impairment in memory, executive function, language, and visuospatial function 1 and 3 months after DBS surgery. Ordinal logistic regressions assessed the association between baseline performance on various cognitive tests and patient-reported domain-specific or simultaneous multi-domain (>1) cognitive decline after surgery.

Results: Lower baseline performance in individual cognitive domains was typically associated with cognitive deficits perceived by the patient after surgery in that same domain. Caregivers reported post-DBS cognitive deficits more frequently than patients, but often misclassified the effected domain.

Multi-domain postoperative cognitive worsening at 1 month was most strongly associated with baseline recognition accuracy on the HVLT-R (all: p=0.002, OR 0.45, CI:0.23-0.75; PD: p=0.015); decline in reading speed on the SCOLP (all: p=0.002, OR 1.95, CI:1.26-3.00; PD: p=0.003), and constructional praxis on the Dementia Rating Scale (all: p=0.01, OR 0.17, CI:0.043-0.65). Multi-domain, patient-reported impairment at 3 months and caregiver-reported cognitive impairment at 1 month were also associated with baseline performance on these same tests, though caregiver-reported cognitive impairment at 3 months post-surgery was predicted only by baseline HVLT-R false-positive recognition score (p=0.034, OR 1.80, CI:1.04-3.09).

Conclusions: While performance in several cognitive domains prior to DBS surgery can predict patient-reported dysfunction in those domains following surgery at 1 and 3 months, multi-domain patient-reported cognitive impairment is most heavily associated with baseline verbal memory, degree of language comprehension decline, and figure construction.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuropsychological-predictors-of-patient-reported-cognitive-outcomes-following-deep-brain-stimulation/