Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease: Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy

Johannes C. Rothlind, Michele K. York, Kim Carlson, Ping Luo, William J. Marks, Frances M. Weaver, Matthew Stern, Kenneth A Follett, Domenic Reda, K. F. Chairpersons, Dolores Ippolito, Gatana Stoner, Tammy Barnett, Ken Bukowski, Rosemarie De Nicolo, Kwan Hur, Joyce Jimenez, Jan Motyka, Theresa Simon, Bharat ThakkarRobert Woolson, Carol Fye, William Gagne, Crystal Harris, Jill Heemskerk, Claudia Moy, Paul Sheehy, Timothy O'Leary, Grant D. Huang, Louis Fiore, Robert Hall, Kevin Stroupe, Kim Burchiel, William Koller, Rajesh Pahwa, Oren Sagher, Roy Bakay, Rick Chappell, Robert Hart, Robert Holloway, George McCabe, Margaret Schenkman, Jamal Taha, Julia Buckelew, Marilyn Garin, Sharon Matzek, Donna Smith, Jeff Bronstein, John Duda, Penelope Hogarth, Stacy Horn, Eugene C. Lai, Ali Samii, Farah Atassi, Cecilia Bello, Lisette Bunting-Perry, Tina Conn, Alice Cugley, Nanette Eubank, Linda Fincher, Romay Franks, Tammy Harris, Mariann Haselman, Susan Heath, Miriam Hirsch, Virginia Janovsky, Elaine Lanier, Mary Lloyd, Susan Loehner, Susan O'Connor, Ligaya Ordonez, Heather Maccarone, Kelli Massey-Makhoul, Mary Matthews, Elizabeth Meyn, Keiko Mimura, Wes Morrow, Tammy Searles, Jamye Valotta, Usha Vasthare, Monica Volz, Constance Ward, Rebecca Warker, Heidi Watson, Pamela Willson, Mark Baron, Matthew Brodsky, Vincent Calabrese, Gordon Campbell, Amy Colcher, Emad Farag, Eva Henry, Jyh Gong Hou, Gail Kang, Galit Kleiner-Fisman, Jeff Kraakevik, John Nutt, Jill Ostrem, Aliya Sarwar, Indu Subramanian, Zeba Vanek, Gordon Baltuch, Antonio De Salles, Jorge Eller, Kathryn Holloway, Paul Larson, Richard Simpson, Philip Starr, William Carne, Tom Erikson, Jeffrey Kreutzer, Mario Mendez, Paul Moberg, John Ragland, Ronald Seel, Elizabeth Soety, Daniel Storzbach, Alexander Troster, Jurg Jaggi

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods: Neuropsychological functioning was assessed in patients with Parkinson's disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results: Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11%) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3%). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions: In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL.

Original languageEnglish (US)
Pages (from-to)622-629
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume86
Issue number6
DOIs
StatePublished - Jun 1 2015

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Deep Brain Stimulation
Parkinson Disease
Therapeutics
Neuropsychological Tests
Therapy
Surgery
Parkinson's Disease
Quality of Life
Subthalamic Nucleus
Globus Pallidus
Short-Term Memory
Outcome Assessment (Health Care)
Learning

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease : Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy. / Rothlind, Johannes C.; York, Michele K.; Carlson, Kim; Luo, Ping; Marks, William J.; Weaver, Frances M.; Stern, Matthew; Follett, Kenneth A; Reda, Domenic; Chairpersons, K. F.; Ippolito, Dolores; Stoner, Gatana; Barnett, Tammy; Bukowski, Ken; De Nicolo, Rosemarie; Hur, Kwan; Jimenez, Joyce; Motyka, Jan; Simon, Theresa; Thakkar, Bharat; Woolson, Robert; Fye, Carol; Gagne, William; Harris, Crystal; Heemskerk, Jill; Moy, Claudia; Sheehy, Paul; O'Leary, Timothy; Huang, Grant D.; Fiore, Louis; Hall, Robert; Stroupe, Kevin; Burchiel, Kim; Koller, William; Pahwa, Rajesh; Sagher, Oren; Bakay, Roy; Chappell, Rick; Hart, Robert; Holloway, Robert; McCabe, George; Schenkman, Margaret; Taha, Jamal; Buckelew, Julia; Garin, Marilyn; Matzek, Sharon; Smith, Donna; Bronstein, Jeff; Duda, John; Hogarth, Penelope; Horn, Stacy; Lai, Eugene C.; Samii, Ali; Atassi, Farah; Bello, Cecilia; Bunting-Perry, Lisette; Conn, Tina; Cugley, Alice; Eubank, Nanette; Fincher, Linda; Franks, Romay; Harris, Tammy; Haselman, Mariann; Heath, Susan; Hirsch, Miriam; Janovsky, Virginia; Lanier, Elaine; Lloyd, Mary; Loehner, Susan; O'Connor, Susan; Ordonez, Ligaya; Maccarone, Heather; Massey-Makhoul, Kelli; Matthews, Mary; Meyn, Elizabeth; Mimura, Keiko; Morrow, Wes; Searles, Tammy; Valotta, Jamye; Vasthare, Usha; Volz, Monica; Ward, Constance; Warker, Rebecca; Watson, Heidi; Willson, Pamela; Baron, Mark; Brodsky, Matthew; Calabrese, Vincent; Campbell, Gordon; Colcher, Amy; Farag, Emad; Henry, Eva; Hou, Jyh Gong; Kang, Gail; Kleiner-Fisman, Galit; Kraakevik, Jeff; Nutt, John; Ostrem, Jill; Sarwar, Aliya; Subramanian, Indu; Vanek, Zeba; Baltuch, Gordon; De Salles, Antonio; Eller, Jorge; Holloway, Kathryn; Larson, Paul; Simpson, Richard; Starr, Philip; Carne, William; Erikson, Tom; Kreutzer, Jeffrey; Mendez, Mario; Moberg, Paul; Ragland, John; Seel, Ronald; Soety, Elizabeth; Storzbach, Daniel; Troster, Alexander; Jaggi, Jurg.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 86, No. 6, 01.06.2015, p. 622-629.

Research output: Contribution to journalArticle

Rothlind, JC, York, MK, Carlson, K, Luo, P, Marks, WJ, Weaver, FM, Stern, M, Follett, KA, Reda, D, Chairpersons, KF, Ippolito, D, Stoner, G, Barnett, T, Bukowski, K, De Nicolo, R, Hur, K, Jimenez, J, Motyka, J, Simon, T, Thakkar, B, Woolson, R, Fye, C, Gagne, W, Harris, C, Heemskerk, J, Moy, C, Sheehy, P, O'Leary, T, Huang, GD, Fiore, L, Hall, R, Stroupe, K, Burchiel, K, Koller, W, Pahwa, R, Sagher, O, Bakay, R, Chappell, R, Hart, R, Holloway, R, McCabe, G, Schenkman, M, Taha, J, Buckelew, J, Garin, M, Matzek, S, Smith, D, Bronstein, J, Duda, J, Hogarth, P, Horn, S, Lai, EC, Samii, A, Atassi, F, Bello, C, Bunting-Perry, L, Conn, T, Cugley, A, Eubank, N, Fincher, L, Franks, R, Harris, T, Haselman, M, Heath, S, Hirsch, M, Janovsky, V, Lanier, E, Lloyd, M, Loehner, S, O'Connor, S, Ordonez, L, Maccarone, H, Massey-Makhoul, K, Matthews, M, Meyn, E, Mimura, K, Morrow, W, Searles, T, Valotta, J, Vasthare, U, Volz, M, Ward, C, Warker, R, Watson, H, Willson, P, Baron, M, Brodsky, M, Calabrese, V, Campbell, G, Colcher, A, Farag, E, Henry, E, Hou, JG, Kang, G, Kleiner-Fisman, G, Kraakevik, J, Nutt, J, Ostrem, J, Sarwar, A, Subramanian, I, Vanek, Z, Baltuch, G, De Salles, A, Eller, J, Holloway, K, Larson, P, Simpson, R, Starr, P, Carne, W, Erikson, T, Kreutzer, J, Mendez, M, Moberg, P, Ragland, J, Seel, R, Soety, E, Storzbach, D, Troster, A & Jaggi, J 2015, 'Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease: Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy', Journal of Neurology, Neurosurgery and Psychiatry, vol. 86, no. 6, pp. 622-629. https://doi.org/10.1136/jnnp-2014-308119
Rothlind, Johannes C. ; York, Michele K. ; Carlson, Kim ; Luo, Ping ; Marks, William J. ; Weaver, Frances M. ; Stern, Matthew ; Follett, Kenneth A ; Reda, Domenic ; Chairpersons, K. F. ; Ippolito, Dolores ; Stoner, Gatana ; Barnett, Tammy ; Bukowski, Ken ; De Nicolo, Rosemarie ; Hur, Kwan ; Jimenez, Joyce ; Motyka, Jan ; Simon, Theresa ; Thakkar, Bharat ; Woolson, Robert ; Fye, Carol ; Gagne, William ; Harris, Crystal ; Heemskerk, Jill ; Moy, Claudia ; Sheehy, Paul ; O'Leary, Timothy ; Huang, Grant D. ; Fiore, Louis ; Hall, Robert ; Stroupe, Kevin ; Burchiel, Kim ; Koller, William ; Pahwa, Rajesh ; Sagher, Oren ; Bakay, Roy ; Chappell, Rick ; Hart, Robert ; Holloway, Robert ; McCabe, George ; Schenkman, Margaret ; Taha, Jamal ; Buckelew, Julia ; Garin, Marilyn ; Matzek, Sharon ; Smith, Donna ; Bronstein, Jeff ; Duda, John ; Hogarth, Penelope ; Horn, Stacy ; Lai, Eugene C. ; Samii, Ali ; Atassi, Farah ; Bello, Cecilia ; Bunting-Perry, Lisette ; Conn, Tina ; Cugley, Alice ; Eubank, Nanette ; Fincher, Linda ; Franks, Romay ; Harris, Tammy ; Haselman, Mariann ; Heath, Susan ; Hirsch, Miriam ; Janovsky, Virginia ; Lanier, Elaine ; Lloyd, Mary ; Loehner, Susan ; O'Connor, Susan ; Ordonez, Ligaya ; Maccarone, Heather ; Massey-Makhoul, Kelli ; Matthews, Mary ; Meyn, Elizabeth ; Mimura, Keiko ; Morrow, Wes ; Searles, Tammy ; Valotta, Jamye ; Vasthare, Usha ; Volz, Monica ; Ward, Constance ; Warker, Rebecca ; Watson, Heidi ; Willson, Pamela ; Baron, Mark ; Brodsky, Matthew ; Calabrese, Vincent ; Campbell, Gordon ; Colcher, Amy ; Farag, Emad ; Henry, Eva ; Hou, Jyh Gong ; Kang, Gail ; Kleiner-Fisman, Galit ; Kraakevik, Jeff ; Nutt, John ; Ostrem, Jill ; Sarwar, Aliya ; Subramanian, Indu ; Vanek, Zeba ; Baltuch, Gordon ; De Salles, Antonio ; Eller, Jorge ; Holloway, Kathryn ; Larson, Paul ; Simpson, Richard ; Starr, Philip ; Carne, William ; Erikson, Tom ; Kreutzer, Jeffrey ; Mendez, Mario ; Moberg, Paul ; Ragland, John ; Seel, Ronald ; Soety, Elizabeth ; Storzbach, Daniel ; Troster, Alexander ; Jaggi, Jurg. / Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease : Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy. In: Journal of Neurology, Neurosurgery and Psychiatry. 2015 ; Vol. 86, No. 6. pp. 622-629.
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abstract = "Background: Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods: Neuropsychological functioning was assessed in patients with Parkinson's disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results: Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11{\%}) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3{\%}). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions: In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL.",
author = "Rothlind, {Johannes C.} and York, {Michele K.} and Kim Carlson and Ping Luo and Marks, {William J.} and Weaver, {Frances M.} and Matthew Stern and Follett, {Kenneth A} and Domenic Reda and Chairpersons, {K. F.} and Dolores Ippolito and Gatana Stoner and Tammy Barnett and Ken Bukowski and {De Nicolo}, Rosemarie and Kwan Hur and Joyce Jimenez and Jan Motyka and Theresa Simon and Bharat Thakkar and Robert Woolson and Carol Fye and William Gagne and Crystal Harris and Jill Heemskerk and Claudia Moy and Paul Sheehy and Timothy O'Leary and Huang, {Grant D.} and Louis Fiore and Robert Hall and Kevin Stroupe and Kim Burchiel and William Koller and Rajesh Pahwa and Oren Sagher and Roy Bakay and Rick Chappell and Robert Hart and Robert Holloway and George McCabe and Margaret Schenkman and Jamal Taha and Julia Buckelew and Marilyn Garin and Sharon Matzek and Donna Smith and Jeff Bronstein and John Duda and Penelope Hogarth and Stacy Horn and Lai, {Eugene C.} and Ali Samii and Farah Atassi and Cecilia Bello and Lisette Bunting-Perry and Tina Conn and Alice Cugley and Nanette Eubank and Linda Fincher and Romay Franks and Tammy Harris and Mariann Haselman and Susan Heath and Miriam Hirsch and Virginia Janovsky and Elaine Lanier and Mary Lloyd and Susan Loehner and Susan O'Connor and Ligaya Ordonez and Heather Maccarone and Kelli Massey-Makhoul and Mary Matthews and Elizabeth Meyn and Keiko Mimura and Wes Morrow and Tammy Searles and Jamye Valotta and Usha Vasthare and Monica Volz and Constance Ward and Rebecca Warker and Heidi Watson and Pamela Willson and Mark Baron and Matthew Brodsky and Vincent Calabrese and Gordon Campbell and Amy Colcher and Emad Farag and Eva Henry and Hou, {Jyh Gong} and Gail Kang and Galit Kleiner-Fisman and Jeff Kraakevik and John Nutt and Jill Ostrem and Aliya Sarwar and Indu Subramanian and Zeba Vanek and Gordon Baltuch and {De Salles}, Antonio and Jorge Eller and Kathryn Holloway and Paul Larson and Richard Simpson and Philip Starr and William Carne and Tom Erikson and Jeffrey Kreutzer and Mario Mendez and Paul Moberg and John Ragland and Ronald Seel and Elizabeth Soety and Daniel Storzbach and Alexander Troster and Jurg Jaggi",
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TY - JOUR

T1 - Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease

T2 - Comparisons of treatment at pallidal and subthalamic targets versus best medical therapy

AU - Rothlind, Johannes C.

AU - York, Michele K.

AU - Carlson, Kim

AU - Luo, Ping

AU - Marks, William J.

AU - Weaver, Frances M.

AU - Stern, Matthew

AU - Follett, Kenneth A

AU - Reda, Domenic

AU - Chairpersons, K. F.

AU - Ippolito, Dolores

AU - Stoner, Gatana

AU - Barnett, Tammy

AU - Bukowski, Ken

AU - De Nicolo, Rosemarie

AU - Hur, Kwan

AU - Jimenez, Joyce

AU - Motyka, Jan

AU - Simon, Theresa

AU - Thakkar, Bharat

AU - Woolson, Robert

AU - Fye, Carol

AU - Gagne, William

AU - Harris, Crystal

AU - Heemskerk, Jill

AU - Moy, Claudia

AU - Sheehy, Paul

AU - O'Leary, Timothy

AU - Huang, Grant D.

AU - Fiore, Louis

AU - Hall, Robert

AU - Stroupe, Kevin

AU - Burchiel, Kim

AU - Koller, William

AU - Pahwa, Rajesh

AU - Sagher, Oren

AU - Bakay, Roy

AU - Chappell, Rick

AU - Hart, Robert

AU - Holloway, Robert

AU - McCabe, George

AU - Schenkman, Margaret

AU - Taha, Jamal

AU - Buckelew, Julia

AU - Garin, Marilyn

AU - Matzek, Sharon

AU - Smith, Donna

AU - Bronstein, Jeff

AU - Duda, John

AU - Hogarth, Penelope

AU - Horn, Stacy

AU - Lai, Eugene C.

AU - Samii, Ali

AU - Atassi, Farah

AU - Bello, Cecilia

AU - Bunting-Perry, Lisette

AU - Conn, Tina

AU - Cugley, Alice

AU - Eubank, Nanette

AU - Fincher, Linda

AU - Franks, Romay

AU - Harris, Tammy

AU - Haselman, Mariann

AU - Heath, Susan

AU - Hirsch, Miriam

AU - Janovsky, Virginia

AU - Lanier, Elaine

AU - Lloyd, Mary

AU - Loehner, Susan

AU - O'Connor, Susan

AU - Ordonez, Ligaya

AU - Maccarone, Heather

AU - Massey-Makhoul, Kelli

AU - Matthews, Mary

AU - Meyn, Elizabeth

AU - Mimura, Keiko

AU - Morrow, Wes

AU - Searles, Tammy

AU - Valotta, Jamye

AU - Vasthare, Usha

AU - Volz, Monica

AU - Ward, Constance

AU - Warker, Rebecca

AU - Watson, Heidi

AU - Willson, Pamela

AU - Baron, Mark

AU - Brodsky, Matthew

AU - Calabrese, Vincent

AU - Campbell, Gordon

AU - Colcher, Amy

AU - Farag, Emad

AU - Henry, Eva

AU - Hou, Jyh Gong

AU - Kang, Gail

AU - Kleiner-Fisman, Galit

AU - Kraakevik, Jeff

AU - Nutt, John

AU - Ostrem, Jill

AU - Sarwar, Aliya

AU - Subramanian, Indu

AU - Vanek, Zeba

AU - Baltuch, Gordon

AU - De Salles, Antonio

AU - Eller, Jorge

AU - Holloway, Kathryn

AU - Larson, Paul

AU - Simpson, Richard

AU - Starr, Philip

AU - Carne, William

AU - Erikson, Tom

AU - Kreutzer, Jeffrey

AU - Mendez, Mario

AU - Moberg, Paul

AU - Ragland, John

AU - Seel, Ronald

AU - Soety, Elizabeth

AU - Storzbach, Daniel

AU - Troster, Alexander

AU - Jaggi, Jurg

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Background: Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods: Neuropsychological functioning was assessed in patients with Parkinson's disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results: Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11%) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3%). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions: In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL.

AB - Background: Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods: Neuropsychological functioning was assessed in patients with Parkinson's disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results: Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11%) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3%). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions: In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL.

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U2 - 10.1136/jnnp-2014-308119

DO - 10.1136/jnnp-2014-308119

M3 - Article

C2 - 25185211

AN - SCOPUS:84929999643

VL - 86

SP - 622

EP - 629

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

SN - 0022-3050

IS - 6

ER -