Objective: To characterize psychiatric profiles of screen failures during evaluation for DBS candidacy for Parkinson disease (PD), dystonia or essential tremor.

Background: DBS is FDA-approved for medically refractory movement disorders. Comprehensive psychiatric screening is essential, as active psychiatric conditions are potential DBS contraindications due to risk of adverse post-operative outcomes, including depression, mania, and suicide. ^1,2 There is a paucity known about patients with movement disorders and comorbid psychiatric disorders who are declined for DBS candidacy.

Method: Retrospective cohort study of patients referred to the University of Florida Fixel Institute for DBS candidacy evaluation (2009-2024). Patients were categorized as approved or screen failures (denied or tabled for re-evaluation). We collected age, gender, race, education, years since movement disorder diagnosis, psychiatric diagnostic information from evaluation by expert psychiatrists, failure reasons, and neuropsychiatric symptom scales (Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Apathy Scale (AS)).

Results: Of 1,758 patients undergoing multidisciplinary review, 182 (10.4%) were screening failures: 117 (6.7%) denied and 65 (3.7%) tabled. Psychiatric concerns ranked third among reasons for screening failure. Among the 28 patients denied or tabled for psychiatric reasons (median age 62 years; 46.4% male; 82.1% white), the primary issues were unstable psychiatric conditions (n=24, 85.7%), lack of prior psychiatric evaluation (n=3, 10.7%), and need for neuropsychiatric re-evaluation (n=1, 3.6%). Accounting for missing data, clinically significant symptoms included depression in 41.6% (BDI-II ≥20)³, apathy in 60.9% (AS ≥14)³, state anxiety in 72.7% (STAI-S ≥40)⁴, and trait anxiety in 65.2% (STAI-T ≥40)⁵. Of the 10 tabled patients for psychiatric reasons, only one with PD was subsequently approved 4 years later after anxiety stabilization.

Conclusion: Unstable psychiatric symptoms were the most common psychiatric reason for a DBS screening failure suggesting that optimization of mental health may benefit potential candidates. These findings underscore the role of comprehensive psychiatric evaluation in multidisciplinary DBS candidacy assessments. These assessments inform risk-benefit discussions regarding post-operative complications.

References: 1. Appleby BS, Duggan PS, Regenberg A, Rabins PV. Psychiatric and Neuropsychiatric Adverse Events Associated With Deep Brain Stimulation: A Meta-Analysis of Ten Years’ Experience. Movement Disorders: Official Journal of the Movement Disorder Society. 2007;22(12):1722-8. doi:10.1002/mds.21551.

2. Anderson KE, Mullins J. Behavioral Changes Associated With Deep Brain Stimulation Surgery for Parkinson’s Disease. Current Neurology and Neuroscience Reports. 2003;3(4):306-13. doi:10.1007/s11910-003-0007-z.

3. De Paepe AE, Wang L, Zhang D, Pascual-Leone A, Kwei K, O’Shea SA, McKhann GM, Baltuch GH, Hamberger M, Cole J, Youngerman BE. Short-term neuropsychiatric outcomes following deep brain stimulation for Parkinson’s disease. Parkinsonism & Related Disorders. 2026;143:108163. doi:10.1016/j.parkreldis.2025.108163.

4. Hinkle JT, Mills KA, Morrow CB, Pontone GM. Anxiety Change After Dopamine Therapy in Parkinson Disease is Independent of Motor Improvement. American Journal of Geriatric Psychiatry. 2024;32(2):220-229. doi:10.1016/j.jagp.2023.09.001. Epub 2023 Sep 10. PMID: 37867011; PMCID: PMC10846408.

5. Weintraub D, Simuni T, Caspell-Garcia C, Coffey C, Lasch S, Siderowf A, Aarsland D, Barone P, Burn D, Chahine LM, Eberling J, Espay AJ, Foster ED, Leverenz JB, Litvan I, Richard I, Troyer MD, Hawkins KA; Parkinson’s Progression Markers Initiative. Cognitive performance and neuropsychiatric symptoms in early, untreated Parkinson’s disease. Movement Disorders. 2015;30(7):919-927. doi:10.1002/mds.26170.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/psychiatric-profile-of-screen-failures-for-deep-brain-stimulation-dbs-candidacy-evaluation-a-retrospective-cohort-study-at-a-large-tertiary-referral-center/