Mosley Philip E, Breakspear Michael, Coyne Terry, Silburn Peter, Smith David
1Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, QLD Australia.
Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, QLD Australia.
NPJ Parkinsons Dis. 2018 Apr 17;4:12. doi: 10.1038/s41531-018-0048-2. eCollection 2018.
Subthalamic deep brain stimulation is an advanced therapy that typically improves quality of life for persons with Parkinson's disease (PD). However, the effect on caregiver burden is unclear. We recruited 64 persons with PD and their caregivers from a movement disorders clinic during the assessment of eligibility for subthalamic DBS. We used clinician-, patient- and caregiver-rated instruments to follow the patient-caregiver dyad from pre- to postoperative status, sampling repeatedly in the postoperative period to ascertain fluctuations in phenotypic variables. We employed multivariate models to identify key drivers of burden. We clustered caregiver-rated variables into 'high' and 'low' symptom groups and examined whether postoperative cluster assignment could be predicted from baseline values. Psychiatric symptoms in the postoperative period made a substantial contribution to longitudinal caregiver burden. The development of stimulation-dependent mood changes was also associated with increased burden. However, caregiver burden and caregiver-rated psychiatric symptom clusters were temporally stable and thus predicted only by their baseline values. We confirmed this finding using frequentist and Bayesian statistics, concluding that in our sample, subthalamic DBS for PD did not significantly influence caregiver burden or caregiver-rated psychiatric symptoms. Specifically, patient-caregiver dyads with high burden and high levels of psychiatric symptoms at baseline were likely to maintain this profile during follow-up. These findings support the importance of assessing caregiver burden prior to functional neurosurgery. Furthermore, they suggest that interventions addressing caregiver burden in this population should target those with greater symptomatology at baseline and may usefully prioritise psychiatric symptoms reported by the caregiver.
丘脑底核深部脑刺激是一种先进的治疗方法，通常可改善帕金森病（PD）患者的生活质量。然而，其对照顾者负担的影响尚不清楚。在评估丘脑底核深部脑刺激的 eligibility 期间，我们从一家运动障碍诊所招募了64名帕金森病患者及其照顾者。我们使用临床医生、患者和照顾者评定的工具，对患者-照顾者二元组从术前到术后的状态进行跟踪，在术后阶段反复抽样以确定表型变量的波动。我们采用多变量模型来确定负担的关键驱动因素。我们将照顾者评定的变量聚类为“高”和“低”症状组，并检查术后聚类分配是否可以根据基线值进行预测。术后的精神症状对照顾者的纵向负担有很大影响。刺激依赖性情绪变化的发展也与负担增加有关。然而，照顾者负担和照顾者评定的精神症状聚类在时间上是稳定的，因此仅由其基线值预测。我们使用频率统计和贝叶斯统计证实了这一发现，得出结论：在我们的样本中，丘脑底核深部脑刺激治疗帕金森病对照顾者负担或照顾者评定的精神症状没有显著影响。具体而言，基线时负担高且精神症状水平高的患者-照顾者二元组在随访期间可能会保持这种状态。这些发现支持了在功能性神经外科手术前评估照顾者负担的重要性。此外，它们表明，针对这一人群照顾者负担的干预措施应针对基线时症状较重的人群，并可能有用地优先考虑照顾者报告的精神症状。
