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Heterogeneity of PD-MCI in Candidates to Subthalamic Deep Brain Stimulation: Associated Cortical and Subcortical
Quentin Devignes1, Sami Daoudi1, Romain Viard2
1Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France.
Background:
Parkinson's disease mild cognitive impairment (PD-MCI) is frequent and heterogenous. There is no consensus about its influence on subthalamic deep brain stimulation (STN-DBS) outcomes.
Objective:
To determine the prevalence of PD-MCI and its subtypes in candidates to STN-DBS. Secondarily, we sought to identify MRI structural markers associated with cognitive impairment in these subgroups.
Methods:
Baseline data from the French multicentric PREDISTIM cohort were used. Candidates to STN-DBS were classified according to their cognitive performance in normal cognition (PD-NC) or PD-MCI. The latter included frontostriatal (PD-FS) and posterior cortical (PD-PC) subtypes. Between-group comparisons were performed on demographical and clinical variables as well as on T1-weighted MRI sequences at the cortical and subcortical levels.
Results:
320 patients were included: 167 (52%) PD-NC and 153 (48%) PD-MCI patients. The latter group included 123 (80%) PD-FS and 30 (20%) PD-PC patients. There was no between-group difference regarding demographic and clinical variables. PD-PC patients had significantly lower global efficiency than PD-FS patients and significantly worse performance on visuospatial functions, episodic memory, and language. Compared to PD-NC, PD-MCI patients had cortical thinning and radiomic-based changes in the left caudate nucleus and hippocampus. There were no significant differences between the PD-MCI subtypes.
Conclusion:
Among the candidates to STN-DBS, a significant proportion has PD-MCI which is associated with cortical and subcortical alterations. Some PD-MCI patients have posterior cortical deficits, a subtype known to be at higher risk of dementia.
Insights
Mild cognitive impairment in Parkinson's disease (PD-MCI) is common in patients undergoing subthalamic deep brain stimulation (STN-DBS). PD-MCI is linked to brain changes, with some subtypes facing higher dementia risk.
Area of Science:
- Neuroscience
- Neurology
- Medical Imaging
Background:
- Parkinson's disease mild cognitive impairment (PD-MCI) is prevalent and heterogeneous.
- Its impact on subthalamic deep brain stimulation (STN-DBS) outcomes remains unclear.
Purpose of the Study:
- Determine PD-MCI prevalence and subtypes in STN-DBS candidates.
- Identify MRI markers associated with cognitive impairment in PD-MCI subtypes.
Main Methods:
- Utilized baseline data from the PREDISTIM cohort (320 patients).
- Classified patients into normal cognition (PD-NC) or PD-MCI (frontostriatal - PD-FS, posterior cortical - PD-PC).
- Performed comparative analyses of demographic, clinical, and T1-weighted MRI data.
Main Results:
- 153/320 (48%) patients had PD-MCI, with 123 (80%) classified as PD-FS and 30 (20%) as PD-PC.
- PD-PC patients showed lower global efficiency and poorer visuospatial, memory, and language performance.
- PD-MCI patients exhibited cortical thinning and altered left caudate nucleus and hippocampus on MRI compared to PD-NC.
Conclusions:
- A significant portion of STN-DBS candidates have PD-MCI, associated with cortical and subcortical alterations.
- The PD-PC subtype, characterized by posterior cortical deficits, may indicate a higher risk for dementia progression.
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