Abstract
Background: Apart from motor manifestations, Parkinson's disease (PD) and associated treatment modalities including DBS are associated with less studied psychiatric and cognitive symptoms. Aim: This study aims to evaluate psychiatric profile, cognition, and quality of life in patients with advanced PD and the effects on STN-DBS on them. Study Design: A prospective, single center, observational study using a direct, structured interview of PD patients. Materials and Methods: All consecutive patients undergoing bilateral STN-DBS between the period June 2017 and December 2019 were evaluated with mini international neuropsychiatric interview (MINI), Addenbrooke's Cognitive Examination (ACE), and PD questionnaire-39 (PDQ-39) before surgery. All these patients were evaluated at 6 weeks postsurgery with MINI and with MINI, ACE and PDQ-39 at 6 months postsurgery. Lead position in magnetic resonance imaging was correlated with psychiatric manifestations. Paired t-test and Wilcoxon sign-rank test were used to study the difference between means. Results: There were a total of 40 cases operated in the study period. There were two patients who had cerebral hemorrhage and two had leads removed due to infection and these patients were excluded from the final analysis. Out of 36 patients, depression was noted in 7 (19.4%), psychosis in 5 (13.8%), anxiety in 10 (27.7%), and suicidal ideation in 2 (5.5%) cases. Postoperatively, 85% of patients with depression, 80% with psychosis, and 80% of patients with anxiety disorders improved. One patient developed new-onset depression and one patient developed visual hallucination. Two patients had acute deterioration in the immediate postoperative period. The patient who developed depression and hallucination had their leads medially located. Mild cognitive decline was noted in verbal fluency which was significant (P = 0.003), and however, there was a significant improvement in quality of life (P = 0.001). Conclusions: Bilateral STN-DBS is a safe and effective therapeutic option and improves psychiatric disorders if the leads are appropriately placed. Although mild cognitive decline occurs, there is overall significant improvement in quality of life.
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