• Maidinamu Yakufujiang, Yoshinori Higuchi, Kyoko Aoyagi, Tatsuya Yamamoto, Toru Sakurai, Midori Abe, Yoji Okahara, Masaki Izumi, Osamu Nagano, Yoshitaka Yamanaka, Shigeki Hirano, Akihiro Shiina, Atsushi Murata, and Yasuo Iwadate.
• Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
• World Neurosurg. 2021 Mar 1; 147: e428-e436.

ObjectiveDeep brain stimulation (DBS) of the bilateral subthalamic nucleus (STN) is a standard surgical treatment option in patients with advanced Parkinson's disease. Adverse effects on cognitive function have been reported, impacting the quality of life of patients and caregivers. We aimed to investigate a quantitative predictive preexisting cognitive factor for predicting postoperative cognitive changes.MethodsThirty-five patients underwent STN-DBS. A battery of neuropsychological tests were used to examine executive function, processing speed, and visuospatial function both preoperatively and 1 year postoperatively. A multiple logistic regression analysis was performed to investigate the relationships between preoperative factors and cognitive outcomes. The predictive value of the preoperative factors for global cognitive decline during long-term follow-up were evaluated.ResultsThe patients exhibited significant changes in processing speed and visuospatial function after surgery. Using reliable change index values, lower preoperative scores on the Similarities and Object Assembly subtests of the Wechsler Adult Intelligence Scale III were associated with decreases in visuospatial function at 1 year after DBS. The odds ratios were 10.2 for Similarities and 9.53 for Object Assembly. The proportion of Mini Mental State Examination-maintained patients with low scores on the Similarities subtest was significantly lower than that of patients with high scores at 3 and 5 years. No factors were found to be related to decreases in processing speed.ConclusionsPreoperative evaluation of the Similarities and Object Assembly subtests may be useful to identify patients who are at a greater risk of experiencing decreases in visuospatial functioning after STN-DBS. Furthermore, a low score on the Similarities subtest may predict future global cognitive deterioration.Copyright © 2020 Elsevier Inc. All rights reserved.

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