Abstract Details

Title Cortical Domain Deficits Do Not Confer Risk for Cognitive Decline in Deep Brain Stimulation (DBS) for Parkinson’s Disease (PD)

Topic Movement Disorders

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-005

Objective Evaluate domain-specific cortical deficits as possible risk factors in motor, medication, mood/adaptivity, and cognitive PD-DBS surgical outcomes.

Background Cognitive deficits in PD are well studied; however, DBS risks posed by mild-moderate deficits in semantic fluency, verbal memory storage, and confrontation naming are not as well understood. The current study examined the post-surgical cognitive, mood/adaptivity, and physical (motor, medication intake) PD patient outcomes through pre/post-DBS neuropsychological and neurological evaluations.

Design/Methods Forty-seven PD-DBS patients (53.2% Hispanic, 70.2% male, 59.6% Spanish-language) of M_age= 64.3 (SD= 9.3; range 43-84), M_{disease_duration_years}= 9.9 (SD= 3.7; range 1-21), M_{education_years}= 15.2 (SD= 3.4), underwent pre- and post-DBS (91% bilateral, 87% subthalamic nucleus) neuropsychological evaluations [M_months= 11.8 (SD=7.2) post-UPDRS after surgery; M_months= 19.6 (SD= 13.0) post-neuropsych after surgery]. Participants were retrospectively stratified into normal, mildly-impaired, and moderately-impaired cognitive ranks by pre-DBS semantic fluency (Animals), naming (BNT), and memory registration (CVLT-3-Recognition) scores. Groups were compared via paired-sample-t-tests of pre- and post-surgery scores at Bonferroni-adjusted alpha=.001.

Results Normal-group verbal memory declined significantly [t(16)=3.9, p=.001], but cognition did not significantly change from pre-to-post-DBS in other groups across language, verbal/visual memory, visuospatial function, processing speed, attention, or executive functioning. Mood/adaptivity (BAI, BDI, PDQ-39-SI) and motor (UPDRS-3 pre-DBS/ON-medication versus post-DBS/ON-stimulation/OFF-medication scores) showed no significant change, although post-DBS/ON-stimulation was clearly better than pre-DBS/ON-medication. Non-significant levodopa-equivalent dose (LED) reductions of 37-50% were noted across groups. In sum, three cognitive groups responded similarly across cognitive, mood/adaptivity, motor, and medication measures.

Conclusions The current study demonstrates that weaknesses in semantic fluency, naming, or verbal memory pre-DBS are not associated with worsened motor, medication, mood/adaptivity, and cognitive outcomes. Normal, mild, and moderate impairment groups benefitted from LED-reduction while maintaining similar UPDRS function. However, future studies with larger sample sizes are needed to help stratify low-and high-risk patients, and caution should still be exercised when determining DBS candidacy of patients with significant cognitive compromise.

Authors/Disclosures
Jessica Herman PRESENTER	Ms. Herman has nothing to disclose.
Scott Harcourt, PhD (Blue Cat Neuropsychology & Intervention, PLLC)	Dr. Harcourt has nothing to disclose.
Aidan T. Kunju (University of Miami Miller School of Medicine)	Mr. Kunju has nothing to disclose.
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.
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.
Bonnie E. Levin, PhD	No disclosure on file
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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