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: 3.97). 03/2011; 17(3):182-8. DOI: 10.1016/j.parkreldis.2010.12.011
Source: PubMed


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.

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    • "Given that apathy is not reversed in all PD patients following DRT, STN DBS in itself may be the cause of apathy in a proportion of patients [62]. The topic warrants further investigations, especially as the most recent STN DBS studies report an increase in frequency and severity of apathy post surgery [62] [63] [64]. As apathy after STN DBS develops progressively in some patients, the role of dopaminergic desensitization rather than a direct stimulation effect has also been postulated [55]. "
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    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.
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    • "However, overall cognition was preserved and anxiety was more improved in that group [100]. Other reported neuropsychiatric adverse effects include anxiety, apathy [101,102], decreased frontal cognitive function [100], decreased executive function [103], impulse control disorders, obsessive-compulsive disorder and aggression [104-108]. Poor pre-operative affective state may predict continued depression post DBS [109], highlighting the need for appropriate pre-surgical patient screening. "
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    ABSTRACT: For the last 50 years, levodopa has been the cornerstone of Parkinson's disease management. However, a majority of patients develop motor complications a few years after therapy onset. Deep brain stimulation has been approved by the FDA as an adjunctive treatment in Parkinson disease, especially aimed at controlling these complications. However, the exact mechanism of action of deep brain stimulation, the best nucleus to target as well as the best timing for surgery are still debatable. We here provide an in-depth and critical review of the current literature on this topic.
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    • "Hardware complications may necessitate a second procedure. Neuropsychiatric adverse effects reported include severe depression, increased suicide risk,52 apathy, anxiety,53,54 decreased frontal cognitive function,55 obsessive–compulsive disorder, impulse control disorders, and aggression.56–60 Recent data suggest bilateral STN stimulation might be associated with some worsening of motor and cognitive performance on complex dual task testing, whereas unilateral STN stimulation would not cause this problem.61 "
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    ABSTRACT: We review the current application of deep brain stimulation (DBS) in Parkinson disease (PD) and consider the evidence that earlier use of DBS confers long-term symptomatic benefit for patients compared to best medical therapy. Electronic searches were performed of PubMed, Web of Knowledge, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials to identify all article types relating to the timing of DBS in PD. Current evidence suggests that DBS is typically performed in late stage PD, a mean of 14 to 15 years after diagnosis. Current guidelines recommend that PD patients who are resistant to medical therapies, have significant medication side effects and lengthening off periods, but are otherwise cognitively intact and medically fit for surgery be considered for DBS. If these criteria are rigidly interpreted, it may be that, by the time medical treatment options have been exhausted, the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. From the evidence available, we conclude that surgical management of PD alone or in combination with medical therapy results in greater improvement of motor symptoms and quality of life than medical treatment alone. There is evidence to support the use of DBS in less advanced PD and that it may be appropriate for earlier stages of the disease than for which it is currently used. The improving short and long-term safety profile of DBS makes early application a realistic possibility. Ann Neurol 2013;73:565–575
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