H - 57 Case Study: Chinese Older Adult with Parkinson Disease and Visual Impairment Presenting for Pre-Deep Brain Stimulation Evaluation.

Abstract

We present a case in which intersecting linguistic and disability factors necessitated a flexible, qualitative approach to clinical decision making in the context of pre-deep brain stimulation (DBS) evaluation. LZ is a 70-year-old, right-handed, cisgender, Chinese male with history of Parkinson disease (PD) presenting for DBS evaluation. Symptoms included right extremity tremor with decreased effectiveness from dopamine therapy. Cognitive, behavioral, personality, or functional changes were denied. He had severe visual impairment due to macular degeneration and cataracts. LZ immigrated to the U.S. 30years prior and obtained a Ph.D. in Law. His English was not at the level of native speaker, but he declined use of an interpreter. Nevertheless, English proficiency was adequate to conduct testing. LZ's premorbid functioning was estimated as average. Scores on attention/working memory and verbal fluency were intact. Processing speed and auditory naming were below average. Memory performance was characterized by inefficient learning and intact recall. Executive functions were variable in verbal set switching and motor sequencing was intact. Typically, such a case with language/cultural differences would rely on more visuospatial than verbal tests; however, visual impairment necessitated reliance on verbal tests only. It was determined that variability of performances and low scores on naming were more likely attributable to language/cultural factors, and LZ was therefore deemed a good candidate for DBS surgery based on multiple intact cognitive abilities and strong social support. LZ received left subthalamic nucleus DBS. There was initial hemorrhagic complication during electrode placement resulting in language loss, which he recovered after five weeks.