Jackowiak Eric, Maher Amanda Cook, Persad Carol, Kotagal Vikas, Wyant Kara, Heston Amelia, Patil Parag G, Chou Kelvin L
Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Parkinsonism Relat Disord. 2020 Sep;78:4-8. doi: 10.1016/j.parkreldis.2020.06.036. Epub 2020 Jul 4.
Caregiver burden (CB) in Parkinson's disease (PD) does not improve in the short term after bilateral subthalamic nucleus (STN) deep brain stimulation (DBS), despite motor improvement. This may be due to increased caregiver demands after surgery or the possibility that DBS unresponsive non-motor factors, such as executive dysfunction, contribute to CB.
To evaluate the trajectory of CB in year 2 following bilateral STN DBS surgery for PD, and to test whether post-operative CB changes correlate with changes in executive function in a subgroup with available neuropsychological testing.
This retrospective analysis included 35 patients with PD whose caregivers completed the Caregiver Burden Inventory (CBI) at baseline and between 9 and 24 months after bilateral STN DBS. 14 of these patients had neuropsychological testing both at baseline and within 6 months of their follow up CBI assessment.
CBI scores showed worsened CB from baseline to follow-up (16.4-21.5, p = 0.006). There was no correlation between change in executive function and change in CBI in the smaller subsample.
CB worsens in the 2 years after bilateral STN DBS despite improvement in motor symptoms and is not associated with change in executive dysfunction in the setting of advancing PD. These findings have implications on pre-operative counselling for patients and caregivers considering DBS for PD.
帕金森病（PD）患者在接受双侧丘脑底核（STN）深部脑刺激（DBS）后，尽管运动功能有所改善，但照顾者负担（CB）在短期内并未得到改善。这可能是由于术后照顾者需求增加，或者是由于DBS无反应的非运动因素（如执行功能障碍）导致了CB。
评估PD患者双侧STN DBS手术后第2年CB的变化轨迹，并在一组可进行神经心理学测试的亚组中，测试术后CB变化是否与执行功能变化相关。
这项回顾性分析纳入了35例PD患者，其照顾者在基线时以及双侧STN DBS术后9至24个月之间完成了照顾者负担量表（CBI）。其中14例患者在基线时以及随访CBI评估的6个月内均进行了神经心理学测试。
CBI评分显示，从基线到随访期间CB有所加重（16.4 - 21.5，p = 0.006）。在较小的亚样本中，执行功能变化与CBI变化之间无相关性。
尽管运动症状有所改善，但双侧STN DBS术后2年内CB仍会加重，且与进展性PD患者执行功能障碍的变化无关。这些发现对考虑为PD患者进行DBS治疗的患者及其照顾者的术前咨询具有启示意义。
