02777nas a2200349 4500008004100000022001400041245012100055210006900176260001200245300001200257490000700269520164600276100001901922700001701941700002201958700002401980700001802004700002402022700001702046700002502063700001802088700002202106700002102128700002302149700002302172700001902195700002402214700002102238700002402259700002602283856011802309 2023 eng d a2330-161900aPatients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation: A Case-Control Study.0 aPatients with Cognitive Impairment in Parkinsons Disease Benefit c03/2023 a382-3910 v103 a

BACKGROUND: Deep brain stimulation (DBS) for Parkinson's disease (PD) is generally contraindicated in persons with dementia but it is frequently performed in people with mild cognitive impairment or normal cognition, and current clinical guidelines are primarily based on these cohorts.

OBJECTIVES: To determine if moderately cognitive impaired individuals including those with mild dementia could meaningfully benefit from DBS in terms of motor and non-motor outcomes.

METHODS: In this retrospective case-control study, we identified a cohort of 40 patients with PD who exhibited moderate (two or more standard deviations below normative scores) cognitive impairment (CI) during presurgical workup and compared their 1-year clinical outcomes to a cohort of 40 matched patients with normal cognition (NC). The surgery targeted subthalamus, pallidus or motor thalamus, in a unilateral, bilateral or staged approach.

RESULTS: At preoperative baseline, the CI cohort had higher Unified Parkinson's Disease Rating Scale (UPDRS) subscores, but similar levodopa responsiveness compared to the NC cohort. The NC and CI cohorts demonstrated comparable degrees of postoperative improvement in the OFF-medication motor scores, motor fluctuations, and medication reduction. There was no difference in adverse event rates between the two cohorts. Outcomes in the CI cohort did not depend on the target, surgical staging, or impaired cognitive domain.

CONCLUSIONS: Moderately cognitively impaired patients with PD can experience meaningful motor benefit and medication reduction with DBS.

1 aBlock, Cady, K1 aPatel, Margi1 aRisk, Benjamin, B1 aStaikova, Ekaterina1 aLoring, David1 aEsper, Christine, D1 aScorr, Laura1 aHigginbotham, Lenora1 aAia, Pratibha1 aDeLong, Mahlon, R1 aWichmann, Thomas1 aFactor, Stewart, A1 aYong, Nicholas, Au1 aWillie, Jon, T1 aBoulis, Nicholas, M1 aGross, Robert, E1 aBuetefisch, Cathrin1 aMiocinovic, Svjetlana uhttps://neurotechcenter.org/publications/2023/patients-cognitive-impairment-parkinsons-disease-benefit-deep-brain