Abstract Details

Title Are Cognitively Impaired Patients Selectively Recruited to Pallidal Deep Brain Stimulation (DBS) in Parkinson’s Disease (PD)?

Topic Movement Disorders

Presentation(s) P5 - Poster Session 5 (11:45 AM-12:45 PM)

Poster/Presentation
Number 5-016

Objective To determine whether demographic cognitive selection bias exists when choosing between STN and GPi as targets for DBS.

Background Though globus pallidus interna (GPi) is reportedly similarly effective to subthalamic nucleus (STN) DBS, offers primary dyskinesia reduction, and has been associated with less postoperative cognitive decline, STN is more frequently selected at many sites. This could be due to an impression that STN is more effective or programmable in practice. We hypothesized this could result in patients thought to be at greater cognitive risk, or with fewer comorbidities, selectively being recruited to GPi vs STN DBS.

Design/Methods We analyzed the pre-DBS demographic and baseline cognitive data of 127 patients who underwent neuropsychological evaluation. We compared performance in global functioning, verbal learning, verbal memory, confrontation naming, phonemic fluency, and semantic fluency between the STN and GPi groups using t tests.

Results 95 STN & 32 GPi implants comprised our cohort. The pre-DBS GPi population was younger (57.6 ± 9.5) compared to STN (63.3 ± 8.6), p = .005. STN patients performed better in semantic fluency as measured by T scores, 50.75 versus 44.28 for the GPi group (p = 0.01). We found no significant difference in disease duration or other cognitive domains analyzed.

Conclusions We found that subjects selected for GPi DBS had worse semantic fluency performance, but other cognitive measures did not differ. Global cognitive performance does not appear to drive DBS selection at our center. Patients selected for GPi targets did not differ in disease duration or severity; however, they were younger. Further investigation will be required to see if phenotype, or psychiatric or medical comorbidities, affect selection. The many preoperative variables (cognition, mood, medication burden, dyskinesia) highlight the importance of an interdisciplinary approach to target selection and a comprehensive analysis of symptoms and risk-benefit profile.

Authors/Disclosures
Sarah Marmol, MD PRESENTER	Dr. Marmol has nothing to disclose.
Matthew Feldman, MD	Dr. Feldman has nothing to disclose.
Scott Harcourt, PhD (Blue Cat Neuropsychology & Intervention, PLLC)	Dr. Harcourt has nothing to disclose.
Annelly Buré-Reyes	Annelly Buré-Reyes has nothing to disclose.
	No disclosure on file
Corneliu C. Luca, MD (University of Miami)	Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boston Scientific. Dr. Luca has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Signant Health. Dr. Luca has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott.
Jonathan Jagid	Jonathan Jagid has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Miami Dade County State Attorneys office. The institution of Jonathan Jagid has received research support from Boston Scientific.
Ihtsham Haq, MD, FAAN (University of Miami Miller School of Medicine)	The institution of Dr. Haq has received research support from NINDS. The institution of Dr. Haq has received research support from the Parkinson's Foundation.
Marina Sarno, Other (University of Miami Department of Neurology)	Dr. Sarno has nothing to disclose.

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