Are there predictors of neuropsychological cognitive decline in Parkinson’s Disease patients who have undergone Deep Brain Stimulation Surgery?
Christine St. Clair1, Sofia Magee2, Christina Palmese3, Joohi Jimenez Shahed3
1Arizona State University, 2William Paterson University, 3Icahn School of Medicine at Mount Sinai
Objective:

To identify determinants of post-Deep Brain Stimulation (DBS) cognitive decline in individuals with Parkinson’s Disease (PD). 




Background:

Pre- and post- operative neuropsychological assessments identify pre-existing cognitive deficits and determine cognitive outcome amongst PD-DBS patients. Post-operative cognitive decline is not well-defined and contributing factors are not well-understood. Declining performance on LM-Delayed Recall (LMDR) indicates memory loss and cognitive decline in PD.


Design/Methods:

We retrospectively reviewed PD-DBS patients who completed DBS workup, surgery and 1-year post-operative neuropsychology testing at a single center between 2015-2022.  Reliable Change Indices (RCI) and Z-scores identified individual clinically significant differences in neurocognitive performance from pre- to post- DBS exams [WMS-IV Logical Memory (LM), HVLT-R, WASI-II].  Patients with clinically significant declining performance on LMDR were identified, yielding groups with and without post-operative cognitive decline. Between-group comparisons of disease features (e.g., duration, L-Dopa burden, DBS target), socio-demographic background, presence of imaging abnormalities (pre- and post- DBS), assessment modality (telehealth vs in-office), and cognitive diagnosis (amnestic vs non-amnestic MCI), were made using t-tests, chi square, and regression analyses.


Results:
62 subjects completed pre- and post-DBS neuropsychological testing. N=18 were excluded (n=8 without PD, n=3 non-English speakers, 7 without pre- and post- WMS-IV testing). Amongst 44 included subjects, there was statistically significant decline in FAS and Animals trials (p <.001, p < .001). N=8 (18%) declined on >1 neurocognitive trials, including LMDR. Between groups with and without cognitive decline, there were no additional significant differences in the assessed baseline variables. N=5 (14%) in the cognitively stable group vs. n=6 (75%) in the cognitively worsened group had postoperative imaging abnormalities (p=0.013) with either edema or hemorrhage.
Conclusions:

18% of PD-DBS patients declined cognitively after surgery. Despite exploring features at both the group and individual levels, no predictors were found, whereas peri- or post-operative factors may contribute.


10.1212/WNL.0000000000203953