Abstract
To more efficiently communicate the results of neuropsychological assessment to interdisciplinary teams, the University of Florida Neuropsychology Service developed a Deep Brain Stimulation-Cognitive Rating Scale (DBS-CRS). This tool condensed results of a 3-h exam into a five-point scale ranging from 1 (least) to 5 (most) cognitive concern for DBS surgery. In this study, we evaluated the role of the DBS-CRS in clinical decisions by the interdisciplinary team to proceed to surgery, its relationship to objective neuropsychological scores, and its predictive utility for clinical outcome. We retrospectively examined 189 patients with Parkinson’s disease who were evaluated for DBS candidacy (mean age 64.8 [SD 9.2], disease duration 8.9 years [SD 5.0], UPDRS-Part III off medication 38.5 [SD 10.5], Dementia Rating Scale-II 135.4 [SD 6.0]). Approximately 19% of patients did not proceed to surgery, with neuropsychological red flags being the most commonly documented reason (57%). Patients who underwent DBS surgery had significantly better DBS-CRS scores than those who did not (p < 0.001). The two strongest and unique neuropsychological contributors to DBS-CRS ratings were delayed memory and executive function, followed by language and visuoperception, based on hierarchical linear regression that accounted for 77.2% of the variance. In terms of outcome, DBS-CRS scores were associated with higher quality of life, less severe motor symptoms, and better daily functioning 6 months following DBS surgery. Together, these findings support the construct and predictive validity of the DBS-CRS as a concise tool for effectively communicating pre-DBS cognitive concerns to an interdisciplinary team, thereby aiding decision making in potential DBS candidates.
Highlights
Deep brain stimulation (DBS) is a powerful treatment which can be used for many of the motor symptoms, and the motor fluctuations, associated with Parkinson’s disease (PD)
Neuropsychological performance was significantly better as a function of Deep Brain Stimulation-Cognitive Rating Scale (DBS-CRS) ratings, with Subgroup 1 > Subgroup 2 > Subgroup 3
Neuropsychologists’ clinical judgment, as summarized by the DBS-CRS tool, plays an important role in the University of Florida’s DBS Fast Track evaluation of whether a patient should proceed to DBS surgery
Summary
Deep brain stimulation (DBS) is a powerful treatment which can be used for many of the motor symptoms, and the motor fluctuations, associated with Parkinson’s disease (PD). DBS involves the implantation of electrical leads deep into the brain and can be applied to one of several target sites—typically the subthalamic nucleus (STN) or the globus pallidus internus (GPi); the DBS-CRS Clinical Use and Validity. DBS leads deliver high-frequency stimulation and are controlled by a pulse generator usually implanted in the chest wall. Selection involves precise diagnosis by fellowship-trained movement disorders neurologists, an assessment of medication response, an interdisciplinary screening, optimal pre-surgical medication management, and formal neuropsychological testing (Okun et al, 2005). Potential DBS candidates are screened for accurate diagnosis, functional disability, and duration, severity, and progression of motor and non-motor symptoms. Many centers follow at least a minimal interdisciplinary team approach, considering neurological, neurosurgical, psychiatric, occupational/physical therapy, and neuropsychological assessment (Abboud et al, 2014)
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