Chang Bowen, Ni Chen, Zhang Weiwen, Mei Jiaming, Xiong Chi, Chen Peng, Jiang Manli, Niu Chaoshi
Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei 230001, China.
Brain Sci. 2022 Jun 9;12(6):759. doi: 10.3390/brainsci12060759.
Parkinson's disease (PD) is a common neurodegenerative disease, for which cognitive impairment is a non-motor symptom (NMS). Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for PD. This study established a nomogram to predict cognitive improvement rate after STN-DBS in PD patients.
We retrospectively analyzed 103 PD patients who underwent STN-DBS. Patients were followed up to measure improvement in MoCA scores one year after surgery. Univariate and multivariate logistic regression analyses were used to identify factors affecting improvement in cognitive status. A nomogram was developed to predict this factor. The discrimination and fitting performance were evaluated by receiver operating characteristics (ROC) analysis, calibration diagram, and decision curve analysis (DCA).
Among 103 patients, the mean improvement rate of the MoCA score was 37.3% and the median improvement rate was 27.3%, of which 64% improved cognition, 27% worsened cognition, and 8.7% remained unchanged. Logistic multivariate regression analysis showed that years of education, UPDRSIII drug use, MoCA Preop, and MMSE Preop scores were independent factors affecting the cognitive improvement rate. A nomogram model was subsequently developed. The C-index of the nomogram was 0.98 (95%CI, 0.97-1.00), and the area under the ROC was 0.98 (95%CI 0.97-1.00). The calibration plot and DCA demonstrated the goodness-of-fit between nomogram predictions and actual observations.
Our nomogram could effectively predict the possibility of achieving good cognitive improvement one year after STN-DBS in patients with PD. This model has value in judging the expected cognitive improvement of patients with PD undergoing STN-DBS.
帕金森病（PD）是一种常见的神经退行性疾病，认知障碍是其非运动症状（NMS）。双侧丘脑底核深部脑刺激（STN-DBS）是治疗PD的一种有效方法。本研究建立了一个列线图，以预测PD患者接受STN-DBS后的认知改善率。
我们回顾性分析了103例接受STN-DBS的PD患者。对患者进行随访，以测量术后一年蒙特利尔认知评估量表（MoCA）评分的改善情况。采用单因素和多因素逻辑回归分析来确定影响认知状态改善的因素。建立了一个列线图来预测该因素。通过受试者工作特征（ROC）分析、校准图和决策曲线分析（DCA）评估判别性能和拟合性能。
103例患者中，MoCA评分的平均改善率为37.3%，中位数改善率为27.3%，其中64%的患者认知得到改善，27%的患者认知恶化，8.7%的患者保持不变。多因素逻辑回归分析显示，受教育年限、左旋多巴等效剂量、术前MoCA评分和术前简易精神状态检查表（MMSE）评分是影响认知改善率的独立因素。随后建立了列线图模型。列线图的C指数为0.98（95%CI，0.97-1.00），ROC曲线下面积为0.98（95%CI 0.97-1.00）。校准图和DCA显示了列线图预测与实际观察之间的良好拟合度。
我们的列线图可以有效预测PD患者接受STN-DBS后一年实现良好认知改善的可能性。该模型在判断接受STN-DBS的PD患者的预期认知改善方面具有价值。
