Semmler Carolin, Stopic Vasilija, Jost Stefanie T, Fink Gereon R, Weiss Peter H, Barbe Michael T
Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Neurology, University Hospital Cologne, Cologne, Germany.
Neurol Res Pract. 2024 Feb 8;6(1):8. doi: 10.1186/s42466-023-00303-2.
While subthalamic nucleus deep brain stimulation (STN-DBS) improves the quality of life (QoL) of patients with Parkinson's disease (PD), the clinical parameters that predict this improvement remain debated. This retrospective study explored whether preoperative motor, cognitive, and affective parameters predict QoL or its components at 6 and 12 months after STN-DBS surgery.
QoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39) before (baseline), at 6 months (N = 90) and 12 months (N = 63) after STN-DBS surgery. Changes in the PDQ-39 and its subdomains were analysed with Wilcoxon signed-rank tests. In total, seven motor, cognitive, and affective parameters recorded at baseline were used in multiple linear regressions to predict QoL and its subdomains.
QoL had improved significantly at six months post STN-DBS surgery. After 12 months, this effect remained significant but was less pronounced. At both time points, significant improvements in mobility, activities of daily living, stigma, and bodily discomfort were present. Correlation and linear regression analyses showed that preoperative QoL status and changes in QoL at 6 and 12 months after surgery were driven by preoperative dopaminergic medication, as well as motor (UPDRS-III medOFF and PIGD-subscore medOFF) and affective (HADS anxiety and depression) symptoms. In contrast, preoperative cognitive performance did not predict QoL at any time point.
Data show that preoperative motor and affective symptoms drive both QoL baseline status and changes in QoL after STN-DBS surgery. Thus, these clinical parameters need to be assessed appropriately to provide comprehensive presurgical advice to patients suffering from PD.
虽然丘脑底核深部脑刺激（STN-DBS）可改善帕金森病（PD）患者的生活质量（QoL），但预测这种改善的临床参数仍存在争议。这项回顾性研究探讨了术前运动、认知和情感参数是否能预测STN-DBS手术后6个月和12个月时的生活质量或其组成部分。
在STN-DBS手术前（基线）、术后6个月（N = 90）和12个月（N = 63）使用帕金森病问卷-39（PDQ-39）评估生活质量。采用Wilcoxon符号秩检验分析PDQ-39及其子领域的变化。总共将基线时记录的七个运动、认知和情感参数用于多元线性回归，以预测生活质量及其子领域。
STN-DBS手术后6个月时生活质量有显著改善。12个月后，这种效果仍然显著，但不太明显。在两个时间点，运动能力、日常生活活动、耻辱感和身体不适均有显著改善。相关性和线性回归分析表明，术前生活质量状态以及术后6个月和12个月时生活质量的变化受术前多巴胺能药物治疗以及运动（非药物状态下的统一帕金森病评定量表第三部分[UPDRS-III medOFF]和姿势不稳和步态障碍亚评分[PIGD-subscore medOFF]）和情感（医院焦虑抑郁量表[HADS]焦虑和抑郁）症状的驱动。相比之下，术前认知表现不能在任何时间点预测生活质量。
数据表明，术前运动和情感症状既驱动生活质量的基线状态，也驱动STN-DBS手术后生活质量的变化。因此，需要适当评估这些临床参数，以便为PD患者提供全面的术前建议。
