Electrode Location and Domain-Specific Cognitive Change Following Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Michael Zargari; Natasha C Hughes; Jeffrey W Chen; Matthew W Cole; Rishabh Gupta; Helen Qian; Jessica Summers; Deeptha Subramanian; Rui Li; Benoit M Dawant; Peter E Konrad; Tyler J Ball; Dario J Englot; Kaltra Dhima; Sarah K Bick

doi:10.1227/neu.0000000000003271

Electrode Location and Domain-Specific Cognitive Change Following Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Neurosurgery. 2024 Nov 8. doi: 10.1227/neu.0000000000003271. Online ahead of print.

Authors

Michael Zargari^{1

2}, Natasha C Hughes^{1

2}, Jeffrey W Chen^{1

3}, Matthew W Cole², Rishabh Gupta⁴, Helen Qian¹, Jessica Summers⁵, Deeptha Subramanian¹, Rui Li⁶, Benoit M Dawant⁶, Peter E Konrad^{1

7}, Tyler J Ball¹, Dario J Englot^{1

8}, Kaltra Dhima⁵, Sarah K Bick^{1

8

9}

Affiliations

¹ Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
² Vanderbilt University, School of Medicine, Nashville, Tennessee, USA.
³ Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
⁴ University of Minnesota - Twin Cities Medical School, Minneapolis, Minnesota, USA.
⁵ Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁷ Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
⁸ Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁹ Department of Psychiatry, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

PMID: 39513712
DOI: 10.1227/neu.0000000000003271

Abstract

Background and objectives: Deep brain stimulation (DBS) is an effective treatment for Parkinson's disease (PD) motor symptoms. DBS is also associated with postoperative cognitive change in some patients. Previous studies found associations between medial active electrode contacts and overall cognitive decline. Our current aim is to determine the relationship between active electrode contact location and domain-specific cognitive changes.

Methods: A single-institution retrospective cohort study was conducted in patients with PD who underwent subthalamic nucleus (STN) DBS from August 05, 2010, to February 22, 2021, and received preoperative and postoperative neuropsychological testing. Standardized norm-referenced test z-scores were categorized into attention, executive function, language, verbal memory, and visuospatial domains. SD change scores were averaged to create domain-specific change scores. We identified anterior commissure/posterior commissure coordinates of active electrode contacts in atlas space. We evaluated differences in active electrode contact location between patients with a domain score decrease of at least 1 SD and less than 1 SD. We performed multiple variable linear regression controlling for age, sex, education, time from surgery to postoperative neuropsychological testing (follow-up duration), disease duration, preoperative unified Parkinson's disease rating scale off medication scores, and preoperative memory scores to determine the relationship between active electrode contact location and domain change.

Results: A total of 83 patients (male: n = 60, 72.3%) were included with a mean age of 63.6 ± 8.3 years, median disease duration of 9.0 [6.0, 11.5] years, and median follow-up duration of 8.0 [7.0, 11.0] months. More superior active electrode contact location in the left STN (P = .002) and higher preoperative memory scores (P < .0001) were associated with worsening memory. Active electrode contact location was not associated with change in other domains.

Conclusion: In patients with PD who underwent STN DBS, we found an association between superior active electrode contacts in the left STN and verbal memory decline. Our study increases understanding of factors associated with cognitive change after DBS and may help inform postoperative programming.

Abstract

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