ABSTRACT
INTRODUCTION: Early postoperative mental changes are the most frequent problem after bilateral subthalamic electrode implantation. The study aims to find an association between them and factors related to patient, disease and surgery, including the size of the third ventricle as brain atrophy marker. MATERIAL AND METHODS: The study included 80 patients with bilateral subthalamic electrodes implanted for motor complications of Parkinson's disease (PD). Patients' age, disease and motor complications duration, medication, neuropsychological tests, surgical reports, third ventricle length (intercommissural distance) and width (intermammillary distance) were analysed. RESULTS: Early mental alterations requiring treatment were observed in 25.0% of patients with higher age being significant predictor. The duration of PD motor complications, L DOPA equivalent dose, DSR Mattis, third ventricle length and width were not statistically significant predictors. The incidence of postoperative mental alteration with intermammillary distance > 8 mm was 60%. The percentage of left sided electrodes implanted in anterior trajectory is significantly higher in patients with early mental changes. CONCLUSIONS: Higher age is a risk factor for early postoperative mental changes, but not disease, late motor complications duration and parameters describing third ventricular size except the excessive intermammillary distance. Left sided electrode implanted in anterior position is a risk factor.
Subject(s)
Mental Disorders/etiology , Mental Disorders/psychology , Postoperative Complications/psychology , Subthalamic Nucleus , Age Factors , Aged , Aged, 80 and over , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/therapeutic use , Deep Brain Stimulation/adverse effects , Electrodes, Implanted , Female , Humans , Levodopa/administration & dosage , Levodopa/therapeutic use , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Parkinson Disease/diagnostic imaging , Parkinson Disease/surgery , Risk Factors , Subthalamic Nucleus/diagnostic imaging , Third VentricleABSTRACT
We report the case history of a 75-year-old woman with Parkinson's disease who developed severe cognitive problems after deep brain stimulation (DBS) of the bilateral subthalamic nuclei (STN). After a brief cognitive improvement, the patient gradually deteriorated until she developed full-blown dementia. We discuss the case with respect to the cognitive effects of STN DBS and the possible risk factors of dementia after STN DBS surgery.
