B.5 Prospective cohort analysis of normal versus mild cognitive impairment for quality of life outcome following DBS for Parkinson’s disease

Abstract

Background: All guidelines for DBS in Parkinson’s disease (PD) include a contraindication for ‘dementia’. It is unclear where this cut-off should occur and if patients with mild cognitive impairment (MCI) do not do as well. This prospective cohort analysis assessed if pre-operative cognition affected post-operative quality of life. Methods: PD patients receiving bilateral STN-DBS (n=100) were prospectively studied using STROBE guidelines. All had Montreal Cognitive Assessment (MoCA), motor (UPDRS), mood (BDI-II), and quality of life (Parkinson Disease Questionnaire summary index, PDQ-39-SI). Two cohorts, pre-operative MCI (MoCA:18-25) and normal cognition (MoCA:26-30), had post-operative PDQ-39-SI at 1-year. The primary outcome was the proportion of patients with an improved PDQ-39-SI at 1-year. Results: Cohorts were not significantly different in age, severity of illness, response to dopamine, or mood. MCI was present in 27/100. Improved quality of life at 1-year occurred in 75% with normal cognition and 70% with MCI (p=0.54) with RR=1.1 (95% CI, 0.8-1.5). Linear regression analysis showed no correlation between pre-operative cognition and post-operative outcome (R²=0.02). Conclusions: Parkinson’s patients with MCI should be offered DBS if their motor symptoms require surgery. Guidelines for DBS surgery in PD should change from “dementia is contraindicated” to “patients require adequate cognitive functioning, MoCA greater than equal to 18.”