Dementia and subthalamic deep brain stimulation in Parkinson disease: A long-term overview

Francesco Bove, Valerie Fraix, Francesco Cavallieri, Emmanuelle Schmitt, Eugénie Lhommée, Amélie Bichon, Sara Meoni, Pierre Pélissier, Andrea Kistner, Eric Chevrier, Claire Ardouin, Patricia Limousin, Paul Krack, Alim Louis Benabid, Stephan Chabardès, Eric Seigneuret, Anna Castrioto, Elena Moro

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To assess the prevalence and the cumulative incidence of dementia at short-, medium- and long-term follow-up after deep brain stimulation (DBS) of the subthalamic nucleus (STN) (at 1, 5, and 10 years) and to evaluate potential risk factors for postoperative dementia.

METHODS: The presence of dementia (according to the DSM-V) was retrospectively evaluated at each postoperative follow-up in patients with Parkinson disease (PD) who underwent bilateral STN-DBS. Preoperative and perioperative risk factors of developing postoperative dementia were also investigated. Demographic data, disease features, medications, comorbidities, nonmotor symptoms, PD motor scales, neuropsychological scales at baseline, and perioperative complications were collected for each patient.

RESULTS: A total of 175 patients were included, and 104 were available at 10-year follow-up. Dementia prevalence was 2.3% at 1 year, 8.5% at 5 years, and 29.8% at 10 years. Dementia cumulative incidence at 1, 5, and 10 years was 2.3%, 10.9%, and 25.7%, respectively. The corresponding dementia incidence rate was 35.6 per 1,000 person-years. Male sex, higher age, hallucinations, lower frontal score at baseline, and perioperative cerebral hemorrhage were predictors of dementia.

CONCLUSIONS: In patients with PD with longstanding STN-DBS, dementia prevalence and incidence are not higher than those reported in the general PD population. Except for few patients with perioperative cerebral hemorrhage, STN-DBS is cognitively safe, and does not provide dementia risk factors in addition to those reported for PD itself. Identification of dementia predictors in this population may improve patient selection and information concerning the risk of poor cognitive outcome.

Original languageEnglish
Pages (from-to)e384-e392
JournalNeurology
Volume95
Issue number4
DOIs
Publication statusPublished - Jul 28 2020
Externally publishedYes

Keywords

  • Adult
  • Aged
  • Deep Brain Stimulation/adverse effects
  • Dementia/epidemiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Parkinson Disease/surgery
  • Prevalence
  • Subthalamic Nucleus

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