Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in Parkinson's disease (PD). Dementia is considered as a contraindication for STN-DBS. However, no controlled study assessed the impact of STN-DBS on the QoL and motor outcome in PD patients with a borderline global cognitive impairment. We studied clinical baseline and progression parameters in a cohort of STN-DBS patients with a global cognitive score still in the non-demented range but scoring in the lowest quartile of the Mattis Dementia Rating Scale (MDRS), a measure of global cognitive functioning. Data from a German randomised controlled study comparing DBS (60 patients) with best medical treatment (BMT, 59 patients) were analysed. Changes in patients' QoL scores were assessed using the Parkinson's disease questionnaire (PDQ-39) at baseline and at the 6 months follow up. Patients were split into four groups according to their MDRS performance at baseline and these groups were compared in the context of motor outcome and QoL. Twelve out of sixty patients of the STN-DBS group scored in the lowest quartile of the MDRS (range between one hundred thirty and one hundred thirty seven points). An individual analysis revealed that 3 of 12 patients showed a clinical relevant improvement in QoL whereas the group statistics did not reveal any significant improvement in QoL measures after STN-DBS compared to the BMT group. Since this failure to improve in QoL cannot be explained by a failure to improve in motor functions, stimulation settings and psychiatric scales after STN-DBS, the failure to improve in QoL in patients with a borderline global cognitive score might be specifically related to lower cognitive functioning.
| Original language | English |
|---|---|
| Journal | Journal of the Neurological Sciences |
| Volume | 310 |
| Issue number | 1-2 |
| Pages (from-to) | 261-266 |
| Number of pages | 6 |
| ISSN | 0022-510X |
| DOIs | |
| Publication status | Published - 15.11.2011 |
Funding
Related to this study: Drs. Bötzel, Deuschl, Krack, Krause, Kupsch, Pinsker, Schnitzler, Sturm, Tronnier, Volkmann, and Wojtecki report having received speaking fees from Medtronic; Drs. Deuschl, Tronnier, Volkmann, and Wojtecki report having received consulting fees from Medtronic; Drs. Deuschl, Kupsch, Krause, Krack, and Volkmann report having received research grants from Medtronic; and Dr. Sturm reports owning stock options from Medtronic. In general: Karsten Witt, MD, PhD: Medical Faculty of the Christian-Albrechts University (CAU), Kiel; grants: German Research Council, International Parkinson Fond, UCB (travel grants); employment: government employee. Christine Daniels, MD: Medical Faculty of the Christian-Albrechts University (CAU), Kiel; employment: government employee. Paul Krack, MD, PhD: Medical Faculty of the Christian-Albrechts University (CAU), Kiel; employment: government employee. Jens Volkmann, MD, PhD: Medical Faculty of the Christian-Albrechts University (CAU), Kiel; advisory boards: GSK, Solvay; honoraria: GSK, Solvay, Desitin; grants: GSK, UCB; employment: government employee; Markus O. Pinsker, MD, PhD: Medical Faculty of the Christian-Albrechts University (CAU), Kiel; employment: government employee. Martin Krause, MD, PhD: Medical Faculty of the Heidelberg University, Heidelberg; employment: government employee. Volker Tronnier, MD, PhD: Medical Faculty of the Heidelberg University, Heidelberg; employment: government employee. Manja Kloss, MD: Medical Faculty of the Heidelberg University, Heidelberg; employment: government employee. Alfons Schnitzler, MD, PhD: Medical Faculty of the Heinrich Heine University, Dusseldorf; advisory boards: Pitie Salpetrière, Novartis, UCB, Cephalon; honoraria: Boehringer Ingelheim, Novartis, UCB, TEVA; grants: DFG, BMBF, Helmholtz Society, Volkswagen Foundation; employment: government employee. Lars Wojtecki, MD: Medical Faculty of the Heinrich Heine University, Dusseldorf; honoraria: Valeant/Meda, Boehringer, Cephalon-Pharma, TEVA, Desitin; grants: St. Jude Medical/ANS, Desitin (travel grants); employment: government employee. Kai Bo tzel, MD, PhD: Medical Faculty of the Ludwig-Maximilians-University, Munich; employment: government employee. Adrian Danek, MD, PhD: Medical Faculty of the Ludwig-Maximilians-University, Munich; employment: government employee. Rudiger Hilker, MD, PhD: Medical Faculty of the Cologne University, Cologne; honoraria: Orion, GlaxoSmithKline, Teva, Cephalon, Desitin, Boehringer Ingelheim; grants: Cephalon (travel grants), Deutsche Parkinson Vereinigung (research funding); employment: government employee. Volker Sturm, MD, PhD: Medical Faculty of the Cologne University, Cologne; employment: government employee. Andreas Kupsch, MD, PhD: Medical Faculty of the Humboldt University, Berlin; honoraria: Allergan, Desitin, GSK, Ipsen, Novartis, Lundbeck; grants: German Research Council, German Ministry of Education and Research; employment: government employee. Elfriede Karner, MPsych: Medical Faculty of the Innsbruck Medical University, Innsbruck; employment: government employee. G. Deuschl, MD, PhD: Medical Faculty of the Christian-Albrechts University (CAU), German Research Council (Popgen), Kompetenznetz Parkinson; honoraria: Lundbeck, Teva; grants: German Research Council, German Ministry of Education and Research; employment: government employee; royalties: Thieme publisher. We thank Carmen Schade-Brittinger and the Koordinationszentrum für Klinische Studien, Marburg, for data management. This study was supported by the Parkinson Foundation Europe and the German Ministry of Research and Technology ( 01GI0201 ) Kompetenznetz Parkinson, TP3. The study is registered at clinicaltrials.gov. Identifier: NCT00196911.
