PT  - JOURNAL ARTICLE
AU  - Bove, Francesco
AU  - Fraix, Valerie
AU  - Cavallieri, Francesco
AU  - Schmitt, Emmanuelle
AU  - Lhommée, Eugénie
AU  - Bichon, Amélie
AU  - Meoni, Sara
AU  - Pélissier, Pierre
AU  - Kistner, Andrea
AU  - Chevrier, Eric
AU  - Ardouin, Claire
AU  - Limousin, Patricia
AU  - Krack, Paul
AU  - Benabid, Alim Louis
AU  - Chabardès, Stephan
AU  - Seigneuret, Eric
AU  - Castrioto, Anna
AU  - Moro, Elena
TI  - Dementia and subthalamic deep brain stimulation in Parkinson disease
AID  - 10.1212/WNL.0000000000009822
DP  - 2020 Jul 28
TA  - Neurology
PG  - e384--e392
VI  - 95
IP  - 4
4099  - http://n.neurology.org/content/95/4/e384.short
4100  - http://n.neurology.org/content/95/4/e384.full
SO  - Neurology2020 Jul 28; 95
AB  - Objectives To assess the prevalence and the cumulative incidence of dementia at short-, medium- and long-term follow-up after deep brain stimulation (DBS) of the subthalamic nucleus (STN) (at 1, 5, and 10 years) and to evaluate potential risk factors for postoperative dementia.Methods The presence of dementia (according to the DSM-V) was retrospectively evaluated at each postoperative follow-up in patients with Parkinson disease (PD) who underwent bilateral STN-DBS. Preoperative and perioperative risk factors of developing postoperative dementia were also investigated. Demographic data, disease features, medications, comorbidities, nonmotor symptoms, PD motor scales, neuropsychological scales at baseline, and perioperative complications were collected for each patient.Results A total of 175 patients were included, and 104 were available at 10-year follow-up. Dementia prevalence was 2.3% at 1 year, 8.5% at 5 years, and 29.8% at 10 years. Dementia cumulative incidence at 1, 5, and 10 years was 2.3%, 10.9%, and 25.7%, respectively. The corresponding dementia incidence rate was 35.6 per 1,000 person-years. Male sex, higher age, hallucinations, lower frontal score at baseline, and perioperative cerebral hemorrhage were predictors of dementia.Conclusions In patients with PD with longstanding STN-DBS, dementia prevalence and incidence are not higher than those reported in the general PD population. Except for few patients with perioperative cerebral hemorrhage, STN-DBS is cognitively safe, and does not provide dementia risk factors in addition to those reported for PD itself. Identification of dementia predictors in this population may improve patient selection and information concerning the risk of poor cognitive outcome.CHU=Centre Hospitalier Universitaire of Grenoble; CI=confidence interval; DBS=deep brain stimulation; DSM-V=Diagnostic and Statistical Manual of Mental Disorders, 5th edition; HR=hazard ratio; LEDD=levodopa equivalent daily dose; PD=Parkinson disease; STN=subthalamic nucleus; WCST=Wisconsin Card Sorting Test