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Abstract
Background This study aims: (1) To compare cognitive and psychiatric outcomes after bilateral awake versus asleep subthalamic nucleus (STN) deep brain stimulation (DBS) surgery for Parkinson’s disease (PD). (2) To explore the occurrence of psychiatric diagnoses, cognitive impairment and quality of life after surgery in our whole sample. (3) To validate whether we can predict postoperative cognitive decline.
Methods 110 patients with PD were randomised to receive awake (n=56) or asleep (n=54) STN DBS surgery. At baseline and 6-month follow-up, all patients underwent standardised assessments testing several cognitive domains, psychiatric symptoms and quality of life.
Results There were no differences on neuropsychological composite scores and psychiatric symptoms between the groups, but we found small differences on individual tests and cognitive domains. The asleep group performed better on the Rey Auditory Verbal Learning Test delayed memory test (f=4.2, p=0.04), while the awake group improved on the Rivermead Behavioural Memory Test delayed memory test. (f=4.4, p=0.04). The Stroop III score was worse for the awake group (f=5.5, p=0.02). Worse scores were present for Stroop I (Stroop word card) (f=6.3, p=0.01), Stroop II (Stroop color card) (f=46.4, p<0.001), Stroop III (Stroop color-word card) (f=10.8, p=0.001) and Trailmaking B/A (f=4.5, p=0.04). Improvements were seen on quality of life: Parkinson’s Disease Questionnaire-39 (f=24.8, p<0.001), and psychiatric scales: Hamilton Depression Rating Scale (f=6.2, p=0.01), and Hamilton Anxiety Rating Scale (f=5.5, p=0.02).
Conclusions This study suggests that the choice between awake and asleep STN DBS does not affect cognitive, mood and behavioural adverse effects, despite a minor difference in memory. STN DBS has a beneficial effect on quality of life, mood and anxiety symptoms.
Trial registration number NTR5809.
- COGNITION
- NEUROPSYCHIATRY
- PARKINSON'S DISEASE
- ELECTRICAL STIMULATION
Data availability statement
Data are available upon reasonable request. Data available: Yes. Data types: De-identified participant data. How to access data: p.r.schuurman@amsterdamumc.nl. When available: With publication Supporting Documents. Document types: None. Additional Information: Who can access the data: With investigators whose proposed use of the data has been approved by an independent review committee from our institution that will be formed for this purpose upon request. Types of analyses: For any purpose approved by the independent review committee. Mechanisms of data availability: To gain access, data requestors will need to sign a data access agreement.
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Data availability statement
Data are available upon reasonable request. Data available: Yes. Data types: De-identified participant data. How to access data: p.r.schuurman@amsterdamumc.nl. When available: With publication Supporting Documents. Document types: None. Additional Information: Who can access the data: With investigators whose proposed use of the data has been approved by an independent review committee from our institution that will be formed for this purpose upon request. Types of analyses: For any purpose approved by the independent review committee. Mechanisms of data availability: To gain access, data requestors will need to sign a data access agreement.
Footnotes
RAH and TJCZ are joint first authors.
RH and TZ contributed equally.
Contributors RH and TZ are co-first authors, contributing equally to this manuscript and the revision, listed alphabetically. All authors contributed to the writing of the manuscript and approved the latest version. DV was involved in the experimental design and implementation of the study. IOB was involved in the statistical analysis and data interpretation. EV and GG were contacted as experts on neuropsychological testing and provided intellectual input to the revision. GvR, PvdM and MB participated in drafting the article and revised it critically with intellectual input. DD and RdB were involved in the critical revision of the final version of the manuscript. RS was principal investigator of this study and participated in the final version of the manuscript. RS is the guarantor of this study, accepting full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests RH and PvdM reported grants from Dutch Brain Foundation during the conduct of the study. DD received grants from ZonMw and Boston Scientific for a trial on deep brain stimulation for depression. RMADB reported grants from Hersenstichting Charitable Organization during the conduct of the study and grants from the Netherlands Organisation for Health Research and Development, Stichting Parkinson Nederland, GE Healthcare, Medtronic, Lysosomal Therapeutics and Neuroderm, all paid to institution, outside the submitted work. RS reported personal fees from Medtronic and Boston Scientific during the conduct of the study.
Provenance and peer review Not commissioned; externally peer reviewed.
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