Revisiting eligibility for deep brain stimulation

Do preoperative mood symptoms predict outcomes in Parkinson's disease patients?

Marina Sarno, Wendy Gaztanaga, Nikhil Banerjee, Annelly Bure-Reyes, Joshua Rooks, Jason Margolesky, Corneliu C Luca, Carlos Singer, Henry P Moore, Jonathan Jagid, Bonnie Levin

Research output: Contribution to journalArticle

Abstract

Introduction: Anxiety and depression are common in PD, occurring in an estimated 30%–40% of PD patients. However, the extent to which these emotional symptoms interfere with Deep Brain Stimulation (DBS) outcomes is not well established. This study examined the association between pre-operative emotional well-being and postsurgical cognitive, emotional, and motor performance in PD. Methods: Forty-nine PD patients underwent neurological, neuropsychological (global cognition, processing speed, language, visuospatial, memory), and emotional assessments pre- and post-DBS. Fifteen patients were administered the UPDRS. Patients were divided into Anxious (Anx; n = 21), Comorbid Anxious and Depressed (Anx + Dep; n = 15), and Emotionally Asymptomatic (EA; n = 13) based on BAI and BDI-II cutoffs, and compared on pre-post changes in neurocognitive, mood, and motor scores using analyses of covariance (ANCOVA), controlling for education, ethnicity, and disease duration. Results: Pre-DBS, there were no significant differences between the three groups on any neuropsychological measure. Overall change from pre-to post-DBS revealed declines on multiple cognitive measures and lower symptom endorsement on the BAI among all participants. No group differences were observed on neurocognitive measures, mood, or UPDRS. Conclusions: PD patients with mild-moderate anxiety or comorbid anxiety/depression pre-DBS do not show greater cognitive, emotional, and motor changes post-DBS compared to emotionally asymptomatic patients. These data emphasize the importance of discussing potential DBS outcomes, while keeping in mind that psychiatric comorbidity should not necessarily exclude patients from DBS. The notion that premorbid mood symptoms could disqualify a candidate for surgery would be a disservice, as this group performs comparably to asymptomatic peers.

Original languageEnglish (US)
JournalParkinsonism and Related Disorders
DOIs
StatePublished - Jan 1 2019

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Deep Brain Stimulation
Parkinson Disease
Anxiety
Depression
Cognition
Psychiatry
Comorbidity
Language
Education

Keywords

  • Anxiety
  • Cognition
  • Deep brain stimulation
  • Depression
  • Motor
  • Parkinson's disease

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

Cite this

Revisiting eligibility for deep brain stimulation : Do preoperative mood symptoms predict outcomes in Parkinson's disease patients? / Sarno, Marina; Gaztanaga, Wendy; Banerjee, Nikhil; Bure-Reyes, Annelly; Rooks, Joshua; Margolesky, Jason; Luca, Corneliu C; Singer, Carlos; Moore, Henry P; Jagid, Jonathan; Levin, Bonnie.

In: Parkinsonism and Related Disorders, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Introduction: Anxiety and depression are common in PD, occurring in an estimated 30{\%}–40{\%} of PD patients. However, the extent to which these emotional symptoms interfere with Deep Brain Stimulation (DBS) outcomes is not well established. This study examined the association between pre-operative emotional well-being and postsurgical cognitive, emotional, and motor performance in PD. Methods: Forty-nine PD patients underwent neurological, neuropsychological (global cognition, processing speed, language, visuospatial, memory), and emotional assessments pre- and post-DBS. Fifteen patients were administered the UPDRS. Patients were divided into Anxious (Anx; n = 21), Comorbid Anxious and Depressed (Anx + Dep; n = 15), and Emotionally Asymptomatic (EA; n = 13) based on BAI and BDI-II cutoffs, and compared on pre-post changes in neurocognitive, mood, and motor scores using analyses of covariance (ANCOVA), controlling for education, ethnicity, and disease duration. Results: Pre-DBS, there were no significant differences between the three groups on any neuropsychological measure. Overall change from pre-to post-DBS revealed declines on multiple cognitive measures and lower symptom endorsement on the BAI among all participants. No group differences were observed on neurocognitive measures, mood, or UPDRS. Conclusions: PD patients with mild-moderate anxiety or comorbid anxiety/depression pre-DBS do not show greater cognitive, emotional, and motor changes post-DBS compared to emotionally asymptomatic patients. These data emphasize the importance of discussing potential DBS outcomes, while keeping in mind that psychiatric comorbidity should not necessarily exclude patients from DBS. The notion that premorbid mood symptoms could disqualify a candidate for surgery would be a disservice, as this group performs comparably to asymptomatic peers.",
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AU - Gaztanaga, Wendy

AU - Banerjee, Nikhil

AU - Bure-Reyes, Annelly

AU - Rooks, Joshua

AU - Margolesky, Jason

AU - Luca, Corneliu C

AU - Singer, Carlos

AU - Moore, Henry P

AU - Jagid, Jonathan

AU - Levin, Bonnie

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