• Ahmad Alhourani, Scott A Wylie, Jessica E Summers, Fenna T Phibbs, Elise B Bradley, Joseph S Neimat, and Nelleke C Van Wouwe.
• Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
• Neurosurgery. 2022 Aug 1; 91 (2): 256262256-262.

BackgroundDeep brain stimulation (DBS) for Parkinson disease provides significant improvement of motor symptoms but can also produce neurocognitive side effects. A decline in verbal fluency (VF) is among the most frequently reported side effects. Preoperative factors that could predict VF decline have yet to be identified.ObjectiveTo develop predictive models of DBS postoperative VF decline using a machine learning approach.MethodsWe used a prospective database of patients who underwent neuropsychological and VF assessment before both subthalamic nucleus (n = 47, bilateral = 44) and globus pallidus interna (n = 43, bilateral = 39) DBS. We used a neurobehavioral rating profile as features for modeling postoperative VF. We constructed separate models for action, semantic, and letter VF. We used a leave-one-out scheme to test the accuracy of the predictive models using median absolute error and correlation with actual postoperative scores.ResultsThe predictive models were able to predict the 3 types of VF with high accuracy ranging from a median absolute error of 0.92 to 1.36. Across all three models, higher preoperative fluency, digit span, education, and Mini-Mental State Examination were predictive of higher postoperative fluency scores. By contrast, higher frontal system deficits, age, Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease scored by the patient, disease duration, and Behavioral Inhibition/Behavioral Activation Scale scores were predictive of lower postoperative fluency scores.ConclusionPostoperative VF can be accurately predicted using preoperative neurobehavioral rating scores above and beyond preoperative VF score and relies on performance over different aspects of executive function.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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