Objective: This study aimed to identify the preoperative cerebral blood flow (CBF) regions associated with frontal lobe dysfunction after subthalamic nucleus deep brain stimulation (STN DBS) in patients with Parkinson’s disease (PD).

Background: STN DBS is an established surgical treatment for the advanced stages of PD, but some patients develop postoperative decline in verbal fluency and executive function. Preoperative evaluation is crucial to reduce the risk of these postoperative frontal lobe dysfunctions, but baseline CBF has not been well studied.

Method: We included 36 patients with PD who underwent STN DBS and were evaluated for neuropsychological tests including Frontal Assessment Battery (FAB) and CBF using single photon emission computed tomography before and 1-y after the surgery. FAB was also evaluated 3-y after the surgery in 23 patients. Additionally, 17 age- and sex-matched healthy controls (HC) were included. Patients with FAB declines ≥ 3 points at 1-y follow-up were defined as the decreased FAB group (dFAB, n=10) and the others as the preserved FAB group (pFAB, n=26). Group comparisons of CBF between two preoperative PD groups under overnight medication discontinuation and between each PD group and the HC group were performed by SPM12 with age and sex as covariates. Statistical thresholds of p < 0.001 for peaks and p < 0.05 for clusters, both uncorrected for multiple comparisons, were employed. Correlations between preoperative CBF in the region of interest and postoperative FAB scores in patients with PD were assessed by Pearson’s correlation.

Results: Preoperative age (mean 63.2 years), disease duration (12.0 years), FAB (16.6 points), MMSE (28.5 points), motor scores, and L-dopa equivalent drug dose did not differ between dFAB and pFAB (p > 0.17). The mean FAB score at 1-y follow-up was 13.0 for dFAB and 16.5 for pFAB (p < 0.001), with no difference in MMSE between the two groups (p = 0.25). Only dFAB showed lower CBF in the bilateral occipital lobes than the HC group (5,836 voxels; Z = 4.56). CBF in the right visual association cortex was lower in dFAB than pFAB (1,126 voxels; Z = 4.57), and positively correlated with FAB scores at 1-y and 3-y follow-up (r = 0.563, p < 0.001; r = 0.602, p = 0.002, respectively).

Conclusion: Occipital hypoperfusion before STN DBS plays an important role in the later development of cognitive dysfunction in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/preoperative-occipital-hypoperfusion-predicts-cognitive-decline-after-subthalamic-nucleus-deep-brain-stimulation-in-parkinsons-disease/