Smoking History Correlates with Worsened Motor and Cognitive Outcomes Following DBS in Parkinson’s Disease
Aidan Kunju1, Jessica Herman1, Marina Sarno1, Scott Harcourt2, Jonathan Jagid1, Corneliu Luca1, Matthew Feldman1, Ihtsham Haq1
1Neurology, University of Miami Miller School of Medicine, 2Blue Cat Neuropsychology & Intervention, PLLC
Objective:
Evaluate the effects of cigarette use on post-surgical outcomes in Parkinson’s Disease (PD) patients following Deep Brain Stimulation (DBS) surgery to aid in risk stratification.
Background:
The impact of smoking on DBS outcomes has scarcely been studied. Smoking is linked to a lower risk of PD and reduced PD-related mortality, although cognitive decline and smoking-related cancers attenuate these benefits. Investigating smoking's effects on post-DBS outcomes may help inform surgical candidacy.
Design/Methods:
Fifty-four PD-DBS patients (Mage_at_DBS=66.1, 14 females, Mdisease_duration=9.8 years) underwent pre- and post-DBS (83% Bilateral, 81% Subthalamic nucleus) neuropsychological evaluations. Neuropsychological data on executive function, attention, language, memory, and visuospatial abilities were standardized. UPDRS scores and Levodopa Equivalent Daily Dose were analyzed. Smoking history (25 smokers, range=1-48 pack-years) was extracted from records. Logistic and linear regressions assessed correlations between smoking and post-DBS motor, medication, and neuropsychological outcomes, adjusting for age, disease duration, education, and sex. Changes in UPDRS and neuropsychological domains were the primary outcomes.
Results:
Years smoking correlated with increased ΔUPDRS (worsening) scores post-DBS, with each additional year correlating to a 0.23-point increase (p=0.019). Pack-years were associated with a decreased likelihood of motor improvement compared to remaining stable after surgery (p=0.022). Pack-years (p=0.018) and female sex (p=0.034) were associated with worsened visuospatial function, and female sex also correlated with worsened attention (p=0.017). No correlations were identified in language, memory, or executive function.
Conclusions:
Smoking history was linked to worsened motor and visuospatial outcomes post-DBS. Sex differences were noted in cognitive outcomes. These negative effects may be mediated by vascular pathologies, warranting further study into the mechanism behind this relationship. Comorbidities like hypertension and diabetes were not accounted for in this study, and doing so will be the next immediate step. Further research is also needed to explore the relationship between smoking, post-surgical complications, and outcomes.
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