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Cognitive changes in Parkinson’s disease during subthalamic stimulation: a clinicopathologic study

¹ Parkinson’s Disease and Movement Disorders Unit, Department of Neurology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Suñer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
² Banco de Tejidos Neurológicos, Universitat de Barcelona-Hospital Clínic, Barcelona, Spain
³ Parkinson’s Disease and Movement Disorders Unit, Department of Neurology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Suñer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
⁴ Department of Neurosurgery, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain

Correspondence to:
Correspondence to:
Dr Francesc Valldeoriola
Neurology Department, Hospital Clínic, C/ Villarroel, 170, 08036-Barcelona, Spain; fvallde@clinic.ub.es

Keywords: behavioural changes; cognitive impairment; Lewy bodies; Parkinson’s disease; subthalamic stimulation

The first 150 words of the full text of this article appear below.

It is well established that patients with Parkinson’s disease (PD) can develop cognitive, behavioural, and mood changes.¹ Cognitive decline has been reported to be present in up to 84% of patients who survive for 15 years after diagnosis.² Several mechanisms may underlie these clinical problems including cholinergic deficiency, dopaminergic dysfunction, prefrontal-caudate nucleus disconnection, and intrinsic limbic and cortical pathology (Lewy bodies, Alzheimer-like changes). Concerns have been raised about the possibility that subthalamic deep brain stimulation (STN-DBS) could also produce cognitive changes and mood and behavioural alterations.^3,4 We report the clinical and neuropathological features of a patient with advanced PD who developed behavioural changes and dementia while on STN-DBS.

CASE REPORT
A 74 year old man suffering from PD for 11 years presented troublesome dyskinesias and unpredictable motor fluctuations that did not respond to multiple changes in medication. The Hoehn and Yahr stage was IV while "off" and III while "on" medication. The . . . [Full text of this article]

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