Neuropsychiatric outcomes after deep brain stimulation for Parkinson's disease - Real-world data from a national movement disorders unit.

BACKGROUND

Effects of subthalamic nucleus Deep Brain Stimulation (DBS) for Parkinson's Disease on neuropsychiatric symptoms remains unclear, especially in the local context.

OBJECTIVES

To describe the frequencies, characteristics, and predictive factors of neuropsychiatric symptoms occurring before and up till 5 years after DBS for Parkinson's disease.

METHOD: Demographic and clinical data from a database of patients who underwent DBS for Parkinson's disease from April 2014 to April 2022 were retrospectively analysed. Neuropsychiatric symptoms were identified from medical records at four time-points: any time pre-DBS, only within 1 year pre-DBS, up to 1-year post-DBS (early-onset), and between 1 and 5 years post-DBS (later-onset). Outcomes included depressed mood, anxiety, cognitive decline, hallucinations, impulse control disorders and poor sleep.

RESULTS

DBS had an early beneficial effect on neuropsychiatric symptoms except for impulse control disorders (12.5% vs 10.4%, p = 1.0 and 10.4% vs 20.8%, p = 0.388) and cognitive decline (10.4% vs 12.5%, p = 1.0 and 10.4% vs 20.8%, p = 0.297). After 1 year, occurrences of neuropsychiatric outcomes approximated pre-DBS frequencies except for excess cognitive decline (52.1% vs 12.5%, p < 0.001 and 52.1% vs 20.8%, p = 0.007). Presence of recent pre-DBS mood symptoms predicted late-onset mood symptoms (adjusted odds ratio = 5.5, 95% CI 1.4-21.3, p = 0.014) and presence of recent pre-DBS hallucinations predicted early-onset post-DBS hallucinations (adjusted odds ratio = 36.4, 95% CI 1.4-962.8, p = 0.031).

CONCLUSION

There are likely at least short-term benefits on neuropsychiatric symptoms after bilateral subthalamic nucleus DBS for Parkinson's Disease.