Abstract
ObjectivesIn the field of Parkinson disease (PD) research, many studies have shown that deep brain stimulation (DBS) can soften side effects, which arise during long‐term medical therapy. This study focuses on the changes in depressive symptoms, quality of life (with the subdivisions physical and mental health), activities of daily living, and subjective memory functioning in PD patients testing the baseline and the outcome 1 year after DBS.MethodsFor the first time, the reliable change index (RCI) methodology was applied to compare PD‐DBS patients (n = 22) with best medically treated PD patients (PD‐BMT; n = 28), subjects with mild cognitive impairment (MCI, n = 43) and healthy controls (n = 25) in the above‐mentioned domains. The used questionnaires included the revised Beck Depression Inventory (BDI‐II), the Short Form (36) Health Survey (SF‐36), the Bayer Activities of Daily Living Scale (B‐ADL), and the Forgetfulness Assessment Inventory (FAI).ResultsThe reliable change indices show high constant or improved results of the PD‐DBS patients in the domains subjective memory (85.7%‐100.0%), activities of daily living (60.0%‐90.0%), physical health summary (77.8%), depressive symptoms (61.9%), and mental health summary (50.0%) in comparison with the PD‐BMT, MCI, and control group.ConclusionsDBS is an established alternative to best medical treatment of PD. The comparisons between the PD‐DBS and PD‐BMT groups do suggest that the domains mental health, depressive symptoms, and physical health benefit most, while the domains activities of daily living and subjective memory functioning are rather constant. Nevertheless, further research is needed to identify mechanisms and predictors that lead to improvement in individual cases.
Highlights
Deep brain stimulation (DBS) of the subthalamic nucleus is an established treatment for severe motor complications in Parkinson disease (PD), and since it is usually a lifelong therapy, it is essential to carefully evaluate beneficial and inadvertent effects in the long term
The reliable change index (RCI) analysis showed an improvement of 42.86% and a deterioration of 38.10% of the Parkinson disease patients with deep brain stimulation (PD‐deep brain stimulation (DBS)) patients for depressive symptoms (BDI‐ II) with no effect (|dppc2| = .000)
The Short Form Health Survey (SF‐36) physical health summary improved in 44.44% and deteriorated in 22.22% of the PD‐DBS patients with a large effect (|dppc2| = .920)
Summary
Deep brain stimulation (DBS) of the subthalamic nucleus is an established treatment for severe motor complications in Parkinson disease (PD), and since it is usually a lifelong therapy, it is essential to carefully evaluate beneficial and inadvertent effects in the long term. The gold standard to evaluate the nonmotor symptoms in PD would be a randomized controlled trial, but this is not suitable for assessing single patients in the clinical setting—the reliable change index (RCI) analysis has been designed.[5] The RCI analysis is capable of examining the influence of the disease progression over time and measures the real change in an individual case. Recent studies have used this RCI methodology to assess the cognitive changes of deep brain stimulated Parkinson patients,[6,7,8,9,10,11] but so far, no study has used it on measuring the psychosocial outcome
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