The trajectory of apathy after deep brain stimulation: From pre-surgery to 6 months post-surgery in Parkinson's disease

Department of Clinical & Health Psychology, College of Public Health and Health, Professions, University of Florida, Box 100165, Gainesville, FL 32610, USA.
Parkinsonism & Related Disorders (Impact Factor: 4.13). 03/2011; 17(3):182-8. DOI: 10.1016/j.parkreldis.2010.12.011
Source: PubMed

ABSTRACT Deep brain stimulation (DBS) has been associated with increased apathy in patients with PD, yet studies lack longitudinal data and have not assessed differences between sites of implantation (i.e. STN versus GPi). We assessed apathy prior to surgery and 6 months post-surgery using a longitudinal design-latent growth curve modeling. We hypothesized that apathy would increase post-surgery, and be related to subthalamic nucleus (versus globus pallidus interna) implantation. Forty-eight PD patients underwent unilateral surgery to either GPi or STN and completed the Apathy Scale prior to surgery and 2, 4, and 6 months post-surgery. Forty-eight matched PD controls completed the Apathy Scale at a 6-month interval. Results indicated apathy increased linearly from pre- to 6-months post-DBS by .66 points bi-monthly, while apathy in the control group did not change. There was no relationship between apathy and DBS site. Higher baseline depression was associated with higher baseline apathy, but not with change in apathy. Middle-aged adults (<65) had a steeper trajectory of apathy than older adults (≥ 65). Apathy trajectory was not related to motor severity, laterality of DBS, levodopa medication reduction, or motor changes after surgery.

Download full-text


Available from: Michael S Okun, Jul 07, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established therapy for patients with Parkinson's disease (PD), especially those with advanced motor complications. The effect of STN DBS on non motor symptoms (NMS) of PD is less well studied. In this article, we review the pertinent literature on the impact of STN DBS on NMS when they co-exist with disabling motor symptoms in PD patients. We also present evidence that the number and the severity of most NMS decrease after STN DBS which can have a major impact on patients' quality of life.
    03/2014; 4(2). DOI:10.3233/JPD-130273
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Deep brain stimulation (DBS) is considered an established treatment for advanced Parkinson’s disease (PD). Nevertheless, some questions remain open. As different nuclei have been stimulated producing a wide number of effects on motor and non-motor symptoms, the first question relates to the issue of which target should be considered. Long-term and convincing data are available on the effects of subthalamus (STN), globus pallidus internus (GPi), and nucleus ventralis intermedius (Vim) of thalamus whereas less evidences have been collected on other deep brain targets, such as pedunculopontine nucleus, centromedian/parafascicular thalamic complex or zona incerta. A recent trial comparing STN and GPi DBS has not shown any substantial differences between both targets and the reasons for this are still unknown. Indeed most clinicians prefer the STN because of its better motor effect and the potential to reduce drug treatment as suggested by several smaller studies. On the other hand, preliminary data suggest a possibly better effect of GPi-stimulation on gait. Smaller studies also suggest advantages for dyskinetic and possibly older patients for the Gpi as a target. The next question is if earlier treatment may improve the course of PD. A small pilot study was positive and modeling of the effects of DBS earlier in the course of the disease supported such an approach but the pivotal study is still lacking.
    12/2012; 2(4):211–219. DOI:10.1016/j.baga.2012.07.001
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Parkinson's disease is a neurodegenerative disorder attributable to midbrain dopaminergic cell loss within the substantia nigra. This causes a dysfunction of the basal ganglia manifested by motor symptoms such as tremor, rigidity, bradykinesia among others. With Deep Brain Stimulation (DBS), neurosurgery has emerged as a therapeutic option, being the subthalamic nucleus its main target area. Studies show significant improvement in motor deficits, but there is no knowledge on the neuropsychological changes in patients after DBS. A review of several studies that have researched the cognitive, emotional and behavioral changes concluded that most cognitive skills are either maintained or improved after DBS, but there may be adverse emotional and behavioral changes that are related to the core brain where the electrode is implanted and with its premorbid personality characteristics.
    09/2011; 18(2):89-98.