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从以患者为中心的角度看脑深部电刺激术后患者个体特征的变化。

A Patient-Centered Perspective on Changes in Personal Characteristics After Deep Brain Stimulation.

机构信息

Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.

Center for Bioethics, Harvard Medical School, Boston, Massachusetts.

出版信息

JAMA Netw Open. 2024 Sep 3;7(9):e2434255. doi: 10.1001/jamanetworkopen.2024.34255.

Abstract

IMPORTANCE

Deep brain stimulation (DBS) results in improvements in motor function and quality of life in patients with Parkinson disease (PD), which might impact a patient's perception of valued personal characteristics. Prior studies investigating whether DBS causes unwanted changes to oneself or one's personality have methodological limitations that should be addressed.

OBJECTIVE

To determine whether DBS is associated with changes in characteristics that patients with PD identify as personally meaningful.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study assessed changes in visual analog scale (VAS) ratings reflecting the extent to which patients with PD manifested individually identified personal characteristics before and 6 and 12 months after DBS at a large academic medical center from February 21, 2018, to December 9, 2021. The VAS findings were tailored to reflect the top 3 individually identified personal characteristics the patient most feared losing. The VASs were scored from 0 to 10, with 0 representing the least and 10 the most extreme manifestation of the trait. Change scores were examined at the individual level. Content analysis was used to code the qualitative data. Qualitative and quantitative analyses were performed from January 12, 2019 (initial qualitative coding), to December 15, 2023.

EXPOSURE

Deep brain stimulation.

MAIN OUTCOMES AND MEASURES

The primary outcome variable was the mean VAS score for the top 3 personal characteristics. The secondary outcome was the incidence of meaningful changes on the patients' top 3 characteristics at the individual level.

RESULTS

Fifty-two of 54 dyads of patients with PD and their care partners (96.3%) were recruited from a consecutive series approved for DBS (36 patients [69.2%] were male and 45 care partners [86.5%] were female; mean [SD] age of patients, 61.98 [8.55] years). Two patients and 1 care partner were lost to follow-up. Increases in the mean VAS score (indicative of greater manifestation of [ie, positive changes in] specific characteristics) were apparent following DBS for ratings of both the patients (Wald χ2 = 16.104; P < .001) and care partners (Wald χ2 = 6.746; P < .001) over time. The slopes of the changes for both the patient and care partners were correlated, indicating agreement in observed changes over time. The individual level analyses indicated that scores for most patients and care partners remained the same or increased.

CONCLUSIONS AND RELEVANCE

In this cohort study, participants reported greater (more positive) manifestations of individually identified, valued characteristics after DBS. These findings may be relevant to informing decision-making for patients with advanced PD who are considering DBS.

摘要

重要性

深部脑刺激(DBS)可改善帕金森病(PD)患者的运动功能和生活质量,这可能会影响患者对自身有价值的个人特征的认知。先前研究表明 DBS 是否会导致对自身或个性的不期望的改变,但这些研究存在方法学上的局限性,需要加以解决。

目的

确定 DBS 是否与 PD 患者认为有个人意义的特征变化有关。

设计、地点和参与者:这项队列研究评估了从 2018 年 2 月 21 日至 2021 年 12 月 9 日,在一家大型学术医疗中心,52 对 PD 患者及其护理人员(96.3%)接受 DBS 治疗前后的视觉模拟量表(VAS)评分变化,以反映患者个人确定的个人特征的程度。VAS 发现针对患者最害怕失去的前 3 个个人特征量身定制。VAS 评分范围从 0 到 10,0 表示特征表现最不明显,10 表示特征表现最明显。个体水平上检查了变化分数。使用内容分析法对定性数据进行编码。定性和定量分析于 2019 年 1 月 12 日(初始定性编码)至 2023 年 12 月 15 日进行。

暴露

深部脑刺激。

主要结局和测量指标

主要结局变量是前 3 个个人特征的平均 VAS 评分。次要结局是患者前 3 个特征在个体水平上发生有意义变化的发生率。

结果

54 对 PD 患者及其护理人员(96.3%)连续接受 DBS 治疗的患者(36 名患者[69.2%]为男性,45 名护理人员[86.5%]为女性;患者平均[标准差]年龄,61.98[8.55]岁)中有 52 对被招募。2 名患者和 1 名护理人员失访。接受 DBS 治疗后,患者(Wald χ2=16.104;P<0.001)和护理人员(Wald χ2=6.746;P<0.001)的 VAS 评分均值(表示特定特征的表现程度[即,阳性变化])均增加。患者和护理人员的变化斜率相关,表明随时间观察到的变化一致。个体水平分析表明,大多数患者和护理人员的评分保持不变或增加。

结论和相关性

在这项队列研究中,参与者报告在接受 DBS 后,他们个人确定的、有价值的特征表现出更大(更积极)的变化。这些发现可能与为考虑 DBS 的晚期 PD 患者提供决策信息相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eed5/11411387/cdc526bc70f1/jamanetwopen-e2434255-g001.jpg

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