Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic.
Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
Eur J Neurosci. 2024 Oct;60(7):5764-5784. doi: 10.1111/ejn.16521. Epub 2024 Aug 30.
Cognitive decline represents a severe non-motor symptom of Parkinson's disease (PD) that can significantly reduce the benefits of subthalamic deep brain stimulation (STN DBS). Here, we aimed to describe post-surgery cognitive decline and identify pre-surgery cognitive profile associated with faster decline in STN DBS-treated PD patients. A retrospective observational study of 126 PD patients treated by STN DBS combined with oral dopaminergic therapy followed for 3.54 years on average (SD = 2.32) with repeated assessments of cognition was conducted. Pre-surgery cognitive profile was obtained via a comprehensive neuropsychological examination and data analysed using exploratory factor analysis and Bayesian generalized linear mixed models. On the whole, we observed a mild annual cognitive decline of 0.90 points from a total of 144 points in the Mattis Dementia Rating Scale (95% posterior probability interval [-1.19, -0.62]) with high inter-individual variability. However, true score changes did not reach previously reported reliable change cut-offs. Executive deficit was the only pre-surgery cognitive variable to reliably predict the rate of post-surgery cognitive decline. On the other hand, exploratory analysis of electrode localization did not yield any statistically clear results. Overall, our data and models imply mild gradual average annual post-surgery cognitive decline with high inter-individual variability in STN DBS-treated PD patients. Nonetheless, patients with worse long-term cognitive prognosis can be reliably identified via pre-surgery examination of executive functions. To further increase the utility of our results, we demonstrate how our models can help with disentangling true score changes from measurement error in future studies of post-surgery cognitive changes.
认知衰退是帕金森病（PD）的一种严重非运动症状，可显著降低丘脑底核深部脑刺激（STN DBS）的获益。在此，我们旨在描述术后认知衰退，并确定与 STN DBS 治疗的 PD 患者更快衰退相关的术前认知特征。我们对 126 例接受 STN DBS 联合口服多巴胺能治疗的 PD 患者进行了回顾性观察性研究，这些患者在平均 3.54 年（SD=2.32）的时间内接受了重复认知评估。术前认知特征通过全面的神经心理学检查获得，并使用探索性因子分析和贝叶斯广义线性混合模型进行数据分析。总的来说，我们观察到 Mattis 痴呆评定量表（MDRS）总分为 144 分，每年认知衰退 0.90 分（95%后验概率区间[-1.19，-0.62]），个体间差异较大。然而，真实得分变化并未达到先前报道的可靠变化临界点。执行功能缺陷是唯一能够可靠预测术后认知衰退速度的术前认知变量。另一方面，对电极定位的探索性分析并未得出任何统计学上明确的结果。总体而言，我们的数据和模型表明，在接受 STN DBS 治疗的 PD 患者中，存在轻度、逐渐的平均年度术后认知衰退，个体间差异较大。尽管如此，通过术前执行功能检查，可以可靠地识别出长期认知预后较差的患者。为了进一步提高我们结果的实用性，我们展示了我们的模型如何帮助在未来的术后认知变化研究中，从测量误差中分离真实得分变化。
