Abstract Details

Title Documentation of Cognitive Diagnoses in Parkinson's Disease Following Deep Brain Stimulation

Topic Movement Disorders

Presentation(s) IN11 - (-)

Poster/Presentation
Number 009

Objective

Background Although cognitive changes in post-DBS PD patients are recognized, the related VA-based diagnostic codes and medications patterns are not well studied.

Design/Methods We report on a subsample of 161 VA-based subjects who were randomized to STN (76) or GPi (85) DBS and followed for 36 months. Data regarding cognitive deficit-related ICD-9 diagnoses (e.g., dementia, memory loss, etc) and treatments with cognitive medications for health care utilization visits was extracted from VA administrative databases.

Results 19 subjects had at least one cognitive diagnosis 6 months prior to surgery. 31 additional subjects had a healthcare utilization visit associated with a cognitive diagnosis by 36 months. The variety of cognitive-related diagnoses post-operatively increased with time: at baseline there were 5 different diagnoses, with 9 more diagnoses recorded by 36 months. The most common diagnosis was the non-specific "Mental Disorder Not Otherwise Specified (MD-NOS)" (46.6%). The prevalence of reported cognitive diagnoses was not different between these two surgical groups at 36 months (p=0.35). Cognitive medication prescriptions increased over time, with 2 medications pre-surgery and 14 at 36 months. Only 24.3% of subjects with a cognitive diagnosis were prescribed a cognitive medication.

Conclusions This VA-based utilization database documents an increase in number and diversity of cognitive diagnoses over time following DBS surgery, with equal frequency in both surgical groups. Post-operative problems, medication changes, or natural disease progression may explain these findings. "Parkinson's disease dementia" was not an available code, and therefore PD-related cognitive deficits are variously coded. Future efforts for a consensus on coding could help study long-term outcomes with greater clarity.

Authors/Disclosures
Brandon R. Barton, MD, FAAN (Rush University Medical Center) PRESENTER	Dr. Barton has nothing to disclose.
	No disclosure on file
Christopher Goetz, MD, FAAN (Rush University Medical Center)	The institution of Dr. Goetz has received research support from Michael J. Fox Foundation. The institution of Dr. Goetz has received research support from NIH. The institution of Dr. Goetz has received research support from Department of Defense. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care. Dr. Goetz has received publishing royalties from a publication relating to health care.
Kevin Stroupe	The institution of Kevin Stroupe has received research support from The Department of Veterans Affairs. Kevin Stroupe has received personal compensation in the range of $100,000-$499,999 for serving as a full-time employee with The Department of Veterans Affairs.
	No disclosure on file
Sean D. Ruland, MD (Loyola University Medical Center)	Dr. Ruland has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up to Date. Dr. Ruland has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Law Firms.

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