Visual Dysfunction is a Risk Factor of Postoperation Delirium in Parkinson Disease

Abstract

To investigate the incidence of and factors influencing postoperative delirium (POD) in Parkinson's disease after deep brain stimulation (DBS) surgery. A total of 272 patients with Parkinson's disease who underwent DBS completed the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q) and underwent neuro-ophthalmologic examinations including optical coherence tomography and fundus vessel analysis. We retrospect the prevalence of POD in groups with different VIPD-Q scores, retinal nerve fiber layer (RNFL) thicknesses, and vessel percentage areas (VPA). A predictive model based on the VIPD-Q was constructed using multivariate logistic regression and verified using bootstrap validation. POD was experienced by 65 (23.9 %) of 272 patients. Patients with PD who had visual impairment (VIPD-Q > 6) had a higher incidence of POD (chi-square, p <0.001). The thickness of the retinal nerve fiber layer and vessel percentage area were also correlated with POD risk. Differences in implantation locations (subthalamic nucleus or pars interna of globus pallidus), operation times, and general anesthesia times did not affect the prevalence of DBS-related POD. A nomogram was constructed based on ophthalmic events to predict the risk of POD. The study findings provide convincing evidence of the relationship between visual dysfunction and the risk of POD. In view of the higher risk of POD, visually impaired patients with PD should undergo closer monitoring after DBS surgery.