Affiliations: Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA | Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA | Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA | School of Medicine, Vanderbilt University, Nashville, TN, USA | Department of Neurology, Loyola University Chicago, Maywood, IL, USA | Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
Note: [] Correspondence to: David Charles, MD, VUMC Department of Neurology, 1161 21st Avenue South, Suite A-1106 MCN, Nashville, TN 37232, USA. Tel.: +1 615 936 0060; Fax: +1 615 936 2675; E-mail: david.charles@vanderbilt.edu
Abstract: Background: Deep brain stimulation (DBS) is an effective treatment for patients with advanced Parkinson's disease (PD) and motor symptom complications. Recently, attention has been focused on whether offering DBS earlier in the course of PD is beneficial. Objective: The purpose of this study was to determine the effects of DBS on neuropsychological functioning in subjects with early stage PD. Methods: Thirty subjects with early PD (Hoehn & Yahr Stage II off medication) were randomized to optimal drug therapy (ODT) (n = 15) or bilateral subthalamic nucleus (STN) DBS+ODT (n = 15) after completing an expanded informed consent process specially designed for the study and administered by a medical ethicist and the study team. Comprehensive neuropsychological testing was completed in the treatment-withdrawn state at baseline and at 12 month and 24 month follow-ups. Results: Two serious adverse events occurred in the DBS+ODT group. One subject experienced a stroke and another developed infected hardware that contributed to specific declines in cognitive functioning. However, compared to the ODT group, the remaining subjects in the DBS+ODT group exhibited modest reductions on a few measures of attention, executive function, and word fluency at 12 months. These differences were largely diminished at 24 months, especially when those with the adverse events were excluded. Conclusions: The results of this trial provide novel data regarding the effects of DBS on cognitive function in early PD. We believe that the findings and insights from this trial can help guide the safety analysis and risk-benefit evaluations in future discussions of DBS in early stage PD.
Keywords: Parkinson's disease, deep brain stimulation, subthalamic nucleus, neuropsychological tests
