Neurological, Neuropsychological, and Neuropsychiatric Assessment of Patients with Parkinson’s Disease for Subthalamic Nucleus Deep Brain Stimulation Surgery
Introduction: Subthalamic nucleus Deep brain stimulation surgery (STN-DBS) is a treatment used for patients in the fluctuating and advanced stages of PD. For this, patients must meet specific inclusion and exclusion criteria. The objectives of this work were to evaluate the current neurological, neuropsychiatric status, and cognitive status of patients with PD for STN-DBS. Methods: A complete semi-structured neurological and neuropsychiatric interview, validated neurological and neuropsychiatric scales, brain MRI, and Levodopa tests, and a complete neuropsychological battery were administered according to CAPSYT recommendations. Results: 48 patients with PD were evaluated; the mean age and schooling were 65.70 years (±8.06), years of illness 15.67 (±7.3), and 12.27 years (±4.28), respectively. Seventeen of these patients were excluded as candidates for neurosurgery. Five patients were excluded due to advanced PD and long disease duration, four patients were excluded due to atypical Parkinsonism, and three patients were excluded due to dementia of multiple domains with a subcortical profile and impairment in daily life activities. Five of these patients were diagnosed with Severe Major Depression Episodes and exhibited more than two of the following conditions: 1) High scores on the Beck Depression Scale; 2) High Okasha suicidality score; 3) High total score on Barrat impulsivity scale; and/or 4) The presence of psychotic symptoms. Conclusions: Our study highlights the relevance of a detailed and complete neurological, neuropsychological, and neuropsychiatric evaluation of PD patients to ensure they are suitable candidates for STN-DBS. The understanding of neurological, neuropsychological symptoms and the evaluation of psychiatric risk factors using validated scales are critical to managing patients before surgery and to guiding post-surgical care.
Cite this paper
Dillon, C. , Laspiur, S. D. , Bellotto, M. , Romano, M. , Vázquez, G. H. , Barisic, M. , Cupito, A. , Jauregui, M. D. , Castro, D. , Leguizamon, P. P. , Viaggio, M. B. and Peralta, C. M. (2026). Neurological, Neuropsychological, and Neuropsychiatric Assessment of Patients with Parkinson’s Disease for Subthalamic Nucleus Deep Brain Stimulation Surgery. Open Access Library Journal, 13, e14986. doi: http://dx.doi.org/10.4236/oalib.1114986.
Weiss, D., Volkmann, J., Fasano, A., Kühn, A., Krack, P. and Deuschl, G. (2021) Changing Gears—DBS for Dopaminergic Desensitization in Parkinson’s Disease? Annals of Neurology, 90, 699-710. https://doi.org/10.1002/ana.26164
Lhommée, E., Wojtecki, L., Czernecki, V., Witt, K., Maier, F., Tonder, L., et al. (2018) Behavioural Outcomes of Subthalamic Stimulation and Medical Therapy versus Medical Therapy Alone for Parkinson’s Disease with Early Motor Complications (EARLYSTIM Trial): Secondary Analysis of an Open-Label Randomised Trial. The Lancet Neurology, 17, 223-231. https://doi.org/10.1016/s1474-4422(18)30035-8
Riley, D.E. and Lang, A.E. (1993) The Spectrum of Levodopa-Related Fluctuations in Parkinson’s Disease. Neurology, 43, 1459-1459. https://doi.org/10.1212/wnl.43.8.1459
Martinez-Fernandez, R., Pelissier, P., Quesada, J., Klinger, H., Lhommée, E., Schmitt, E., et al. (2015) Postoperative Apathy Can Neutralise Benefits in Quality of Life after Subthalamic Stimulation for Parkinson’s Disease. Journal of Neurology, Neurosurgery & Psychiatry, 87, 311-318. https://doi.org/10.1136/jnnp-2014-310189
Maricle, R.A., Nutt, J.G., Valentine, R.J. and Carter, J.H. (1995) Dose-Response Relationship of Levodopa with Mood and Anxiety in Fluctuating Parkinson’s Disease: A Double-Blind, Placebo-Controlled Study. Neurology, 45, 1757-1760. https://doi.org/10.1212/wnl.45.9.1757
Bejjani, B., Arnulf, I., Demeret, S., Damier, P., Bonnet, A., Houeto, J., et al. (2000) Levodopa-Induced Dyskinesias in Parkinson’s Disease: Is Sensitization Reversible? Annals of Neurology, 47, 655-658. https://doi.org/10.1002/1531-8249(200005)47:5<655::aid-ana16>3.3.co;2-r
Funkiewiez, A., Ardouin, C., Krack, P., Fraix, V., Van Blercom, N., Xie, J., et al. (2003) Acute Psychotropic Effects of Bilateral Subthalamic Nucleus Stimulation and Levodopa in Parkinson’s Disease. Movement Disorders, 18, 524-530. https://doi.org/10.1002/mds.10441
Witjas, T., Kaphan, E., Régis, J., Jouve, E., Chérif, A.A., Péragut, J., et al. (2007) Effects of Chronic Subthalamic Stimulation on Nonmotor Fluctuations in Parkinson’s Disease. Movement Disorders, 22, 1729-1734. https://doi.org/10.1002/mds.21602
Defer, G., Widner, H., Marié, R., Rémy, P. and Levivier, M. (1999) Core Assessment Program for Surgical Interventional Therapies in Parkinson’s Disease (CAPSIT-PD). Movement Disorders, 14, 572-584. https://doi.org/10.1002/1531-8257(199907)14:4<572::aid-mds1005>3.0.co;2-c
Pham, U., Solbakk, A., Skogseid, I., Toft, M., Pripp, A.H., Konglund, A.E., et al. (2015) Personality Changes after Deep Brain Stimulation in Parkinson’s Disease. Parkinson’s Disease, 2015, Article ID: 490507. https://doi.org/10.1155/2015/490507
Poewe, W., Gauthier, S., Aarsland, D., Leverenz, J.B., Barone, P., Weintraub, D., et al. (2008) Diagnosis and Management of Parkinson’s Disease Dementia. International Journal of Clinical Practice, 62, 1581-1587. https://doi.org/10.1111/j.1742-1241.2008.01869.x
BECK, A.T., Ward, C. H., Mendelson, M., Mock, J., Erbaugh, J. (1961) An Inventory for Measuring Depression. Archives of General Psychiatry, 4, 561-571. https://doi.org/10.1001/archpsyc.1961.01710120031004
Diez-Quevedo, C., Rangil, T., Sanchez-Planell, L., Kroenke, K. and Spitzer, R.L. (2001) Validation and Utility of the Patient Health Questionnaire in Diagnosing Mental Disorders in 1003 General Hospital Spanish Inpatients. Psychosomatic Medicine, 63, 679-686. https://doi.org/10.1097/00006842-200107000-00021
Saldivia, S., Aslan, J., Cova, F., Vicente, B., Inostroza, C. and Rincón, P. (2019) Propiedades psicométricas del PHQ-9 (Patient Health Questionnaire) en centros de atención primaria de Chile. Revista médica de Chile, 147, 53-60. https://doi.org/10.4067/s0034-98872019000100053
Garcia-Campayo, J., Zamorano, E., Ruiz, M.A., Pardo, A., Perez-Paramo, M., Lopez-Gomez, V., et al. (2010) Cultural Adaptation into Spanish of the Generalized Anxiety Disorder-7 (GAD-7) Scale as a Screening Tool. Health and Quality of Life Outcomes, 8, Article No. 8. https://doi.org/10.1186/1477-7525-8-8
Spitzer, R.L., Kroenke, K., Williams, J.B.W. and Löwe, B. (2006) A Brief Measure for Assessing Generalized Anxiety Disorder. Archives of Internal Medicine, 166, 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
Okasha, A., Lotaif, F. and Sadek, A. (1981) Prevalence of Suicidal Feelings in a Sample of Non-Consulting Medical Students. Acta Psychiatrica Scandinavica, 63, 409-415. https://doi.org/10.1111/j.1600-0447.1981.tb00690.x
Salvo G, L., Melipillán A, R. and Castro S, A. (2009) Confiabilidad, validez y punto de corte para escala de screening de suicidalidad en adolescentes. Revista chilena de neuro-psiquiatría, 47, 16-23. https://doi.org/10.4067/s0717-92272009000100003
Marin, R.S., Biedrzycki, R.C. and Firinciogullari, S. (1991) Reliability and Validity of the Apathy Evaluation Scale. Psychiatry Research, 38, 143-162. https://doi.org/10.1016/0165-1781(91)90040-v
Starkstein, S.E., Mayberg, H.S., Preziosi, T.J., Andrezejewski, P., Leiguarda, R. and Robinson, R.G. (1992) Reliability, Validity, and Clinical Correlates of Apathy in Parkin-son’s Disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 4, 134-139. https://doi.org/10.1176/jnp.4.2.134
Barratt, E.S. (1995) Impulsiveness and Aggression. In: Monahan, J. and Steadman, H.J., Eds., Violence and Mental Disorder: Development in Risk Assessment, University of Chicago Press, 61-79.
Oquendo, M.A., Baca-Garcia, E., Graver, R., Morales, M., Montal, V. and Mann, J.J. (2001) Spanish Adaptation of the Barratt Impulsiveness Scale (BIS-11). The European Journal of Psychiatry, 15, 147-155.
Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A. and Gornbein, J. (1994) The Neuropsychiatric Inventory: Comprehensive Assessment of Psychopathology in Dementia. Neurology, 44, 2308-2308. https://doi.org/10.1212/wnl.44.12.2308
Miranda, J.P. and Valencia, R.R. (1997) English and Spanish Versions of a Memory Test: Word-Length Effects versus Spoken-Duration Effects. Hispanic Journal of Behavioral Sciences, 19, 171-181. https://doi.org/10.1177/07399863970192005
Allegri, R.F., Villavicencio, A.F., Taragano, F.E., Rymberg, S., Mangone, C.A. and Baumann, D. (1997) Spanish Boston Naming Test Norms. The Clinical Neuropsychologist, 11, 416-420. https://doi.org/10.1080/13854049708400471
Serrano, C.M., Allegri, R.F., Drake, M., Butman, J., Harris, P., Nagle, C., et al. (2001) Versión abreviada en español del test de denominación de Boston: Su utilidad en el diagnóstico diferencial de la enfermedad de Alzheimer. Revista de Neurología, 33, 624-627. https://doi.org/10.33588/rn.3307.2001238
Reitan, R.M. (1958) Validity of the Trail Making Test as an Indicator of Organic Brain Damage. Perceptual and Motor Skills, 8, 271-276. https://doi.org/10.2466/pms.8.7.271-276
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000) The Fab: A Frontal Assessment Battery at Bedside. Neurology, 55, 1621-1626. https://doi.org/10.1212/wnl.55.11.1621
Dillon, C., Leis, A., Castro, D.M., García, V., Zegarra, C., Perez Leguizamón, P., et al. (2022) Estudio de síntomas neuropsiquiátricos y neuropsicológicos en pacientes con enfermedad de Parkinson seleccionados para la cirugía de estimulación cerebral profunda. Neurología Argentina, 14, 229-238. https://doi.org/10.1016/j.neuarg.2022.06.001
Dillon, C., Tartaglini, M.F., Stefani, D., Salgado, P., Taragano, F.E. and Allegri, R.F. (2014) Geriatric Depression and Its Relation with Cognitive Impairment and Dementia. Archives of Gerontology and Geriatrics, 59, 450-456. https://doi.org/10.1016/j.archger.2014.04.006
Dillon, C., Machnicki, G., Serrano, C.M., Rojas, G., Vazquez, G. and Allegri, R.F. (2011) Clinical Manifestations of Geriatric Depression in a Memory Clinic: Toward a Proposed Subtyping of Geriatric Depression. Journal of Affective Disorders, 134, 177-187. https://doi.org/10.1016/j.jad.2011.05.036
Dillon, C., Allegri, R.F., Serrano, C.M., Iturry, M., Salgado, P., Glaser, F.B. and Taragano, F.E. (2009) Late- Versus Early-Onset Geriatric Depression in a Memory Research Center. Neuropsychiatric Disease and Treatment, 5, 517-526. https://doi.org/10.2147/ndt.s7320
Chagas, M.H.N., Tumas, V., Rodrigues, G.R., Machado-de-Sousa, J.P., Filho, A.S., Hallak, J.E.C., et al. (2013) Validation and Internal Consistency of Patient Health Questionnaire-9 for Major Depression in Parkinson’s Disease. Age and Ageing, 42, 645-649. https://doi.org/10.1093/ageing/aft065
Whitman, M.R., Tylicki, J.L., Mascioli, R., Pickle, J. and Ben-Porath, Y.S. (2021) Psychometric Properties of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) in a Clinical Neuropsychology Setting. Psychological Assessment, 33, 142-155. https://doi.org/10.1037/pas0000969
Montgomery, S.A. and Åsberg, M. (1979) A New Depression Scale Designed to Be Sensitive to Change. British Journal of Psychiatry, 134, 382-389. https://doi.org/10.1192/bjp.134.4.382
Patton, J.H., Stanford, M.S. and Barratt, E.S. (1995) Factor Structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology, 51, 768-774. https://doi.org/10.1002/1097-4679(199511)51:6<768::aid-jclp2270510607>3.0.co;2-1
Stanford, M.S., Mathias, C.W., Dougherty, D.M., Lake, S.L., Anderson, N.E. and Patton, J.H. (2009) Fifty Years of the Barratt Impulsiveness Scale: An Update and Review. Personality and Individual Differences, 47, 385-395. https://doi.org/10.1016/j.paid.2009.04.008
Remy, P., Doder, M., Lees, A., Turjanski, N. and Brooks, D. (2005) Depression in Parkinson’s Disease: Loss of Dopamine and Noradrenaline Innervation in the Limbic System. Brain, 128, 1314-1322. https://doi.org/10.1093/brain/awh445
Prange, S., Klinger, H., Laurencin, C., Danaila, T. and Thobois, S. (2022) Depression in Patients with Parkinson’s Disease: Current Understanding of Its Neurobiology and Implications for Treatment. Drugs & Aging, 39, 417-439. https://doi.org/10.1007/s40266-022-00942-1
Poletti, M. and Bonuccelli, U. (2012) Impulse Control Disorders in Parkinson’ Disease: The Role of Personality and Cognitive Status. Journal of Neurology, 259, 2269-2277. https://doi.org/10.1007/s00415-012-6506-6
Brandão, P.R.P., Munhoz, R.P., Grippe, T.C., Cardoso, F.E.C., de Almeida e Castro, B.M., Titze-de-Almeida, R., et al. (2020) Cognitive Impairment in Parkinson’s Disease: A Clinical and Pathophysiological Overview. Journal of the Neurological Sciences, 419, Article ID: 117177. https://doi.org/10.1016/j.jns.2020.117177
Aarsland, D., Larsen, J.P., Lim, N.G., Janvin, C., Karlsen, K., Tandberg, E., et al. (1999) Range of Neuropsychiatric Disturbances in Patients with Parkinson’s Disease. Journal of Neurology, Neurosurgery & Psychiatry, 67, 492-496. https://doi.org/10.1136/jnnp.67.4.492
Dillon, C., Serrano, C.M., Castro, D., Heisecke, S.L., Taragano, F.E. and Perez Leguizamon, P. (2013) Behavioral Symptoms Related to Cognitive Impairment. Neuropsychiatric Disease and Treatment, 2013, 1443-1455. https://doi.org/10.2147/ndt.s47133
