Objective: To analyze quality of life (QoL) changes after subthalamic stimulation (STN-DBS) based on a short list of baseline nonmotor and motor symptoms in Parkinson’s disease (PD).

Background: STN-DBS improves QoL, motor, and nonmotor symptoms (NMS) in advanced PD. However, substantial inter-individual variability has been observed for postoperative QoL outcome.

Method: In this ongoing, prospective, observational, multicenter study, we first conducted a K-means clustering analysis of 20 variables. These included preoperative baseline z-scores of NMSScale (NMSS) total and domain scores, Hospital Anxiety and Depression Scale (HADS)-anxiety and depression subscores, Scales for Outcomes in Parkinson’s disease (SCOPA)-motor examination total and subscores for tremor, akinesia, rigidity, postural instability and gait difficulty, percentage of motor response in levodopa challenge test, disease duration, and age at intervention. We used Kruskal-Wallis-test (K-W) to analyze differences of PDQuestionnaire (PDQ)-8 changes at postoperative 6-month follow-up between clusters. In a second step, discriminant analysis reduced the number of classification variables and K-W confirmed PDQ-8 outcome differences between these groups.

Results: 115 patients were categorized in three clusters based on the 20 baseline parameters. Their PDQ-8 outcomes differed significantly (p=0.015). Discriminant analysis reduced the number of variables to six (NMSS total, NMSS sleep, urinary, and miscellaneous domains, HADS-anxiety, SCOPA-motor examination total). These categorized 91.6% of patients correctly to previously identified clusters. Finally, in a cohort of 183 patients, K-W confirmed group differences of PDQ-8 outcomes (p=0.007). Effect sizes of PDQ-8 SI changes were large in the group with higher nonmotor and motor symptoms burden (0.85), negligible in the group with lower burden (0.14) and moderate in the intermediate group (0.45).

Conclusion: Clustering and discriminant analysis applied on a big dataset including 20 variables from 183 patients undergoing STN-DBS for PD identified a short list of six motor and nonmotor variables which stratified for clinically important differences of QoL outcomes. We advocate the assessment of these motor and nonmotor aspects of PD to support patient advisement and monitoring in line with the concept of personalized medicine.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quality-of-life-changes-after-subthalamic-stimulation-for-parkinsons-disease-depend-on-nonmotor-and-motor-symptoms-clusters/