Kenney Lauren, Rohl Brittany, Lopez Francesca V, Lafo Jacob A, Jacobson Charles, Okun Michael S, Foote Kelly D, Bowers Dawn
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States.
Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States.
Front Hum Neurosci. 2020 Sep 29;14:578216. doi: 10.3389/fnhum.2020.578216. eCollection 2020.
To more efficiently communicate the results of neuropsychological assessment to interdisciplinary teams, the University of Florida Neuropsychology Service developed a Deep Brain Stimulation-Cognitive Rating Scale (DBS-CRS). This tool condensed results of a 3-h exam into a five-point scale ranging from 1 (least) to 5 (most) cognitive concern for DBS surgery. In this study, we evaluated the role of the DBS-CRS in clinical decisions by the interdisciplinary team to proceed to surgery, its relationship to objective neuropsychological scores, and its predictive utility for clinical outcome. We retrospectively examined 189 patients with Parkinson's disease who were evaluated for DBS candidacy (mean age 64.8 [ 9.2], disease duration 8.9 years [ 5.0], UPDRS-Part III off medication 38.5 [ 10.5], Dementia Rating Scale-II 135.4 [ 6.0]). Approximately 19% of patients did not proceed to surgery, with neuropsychological red flags being the most commonly documented reason (57%). Patients who underwent DBS surgery had significantly better DBS-CRS scores than those who did not ( < 0.001). The two strongest and unique neuropsychological contributors to DBS-CRS ratings were delayed memory and executive function, followed by language and visuoperception, based on hierarchical linear regression that accounted for 77.2% of the variance. In terms of outcome, DBS-CRS scores were associated with higher quality of life, less severe motor symptoms, and better daily functioning 6 months following DBS surgery. Together, these findings support the construct and predictive validity of the DBS-CRS as a concise tool for effectively communicating pre-DBS cognitive concerns to an interdisciplinary team, thereby aiding decision making in potential DBS candidates.
为了更有效地向跨学科团队传达神经心理学评估结果，佛罗里达大学神经心理学服务部开发了一种深部脑刺激认知评定量表（DBS-CRS）。该工具将一项3小时检查的结果浓缩为一个五点量表，从对深部脑刺激手术的认知担忧程度1（最低）到5（最高）。在本研究中，我们评估了DBS-CRS在跨学科团队决定是否进行手术的临床决策中的作用、它与客观神经心理学评分的关系以及它对临床结果的预测效用。我们回顾性研究了189例接受深部脑刺激候选资格评估的帕金森病患者（平均年龄64.8[9.2]岁，病程8.9年[5.0]，未服用药物时统一帕金森病评定量表第三部分评分为38.5[10.5]，痴呆评定量表第二版评分为135.4[6.0]）。约19%的患者未进行手术，神经心理学警示信号是最常见的记录原因（57%）。接受深部脑刺激手术的患者的DBS-CRS评分显著高于未接受手术的患者（<0.001）。基于层次线性回归，对DBS-CRS评分贡献最大且独特的两个神经心理学因素是延迟记忆和执行功能，其次是语言和视觉感知，这两个因素解释了77.2%的方差。在结果方面，DBS-CRS评分与深部脑刺激手术后6个月更高的生活质量、较轻的运动症状和更好的日常功能相关。总之，这些发现支持了DBS-CRS作为一种简洁工具的结构效度和预测效度，该工具可有效地向跨学科团队传达深部脑刺激术前的认知担忧，从而有助于潜在深部脑刺激候选者的决策。
