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Parkinson disease and STN-DBS: cognitive effects in GBA mutation carriers

Pal, G; Mangone, G; Hill, EJ; Ouyang, B; Liu, Y; Lythe, V; Ehrlich, D; ... Goetz, CG; + view all (2022) Parkinson disease and STN-DBS: cognitive effects in GBA mutation carriers. Annals of Neurology 10.1002/ana.26302. (In press).

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Abstract

OBJECTIVE: To compare the rate of change in cognition between glucocerebrosidase (GBA) mutation carriers and non-carriers with and without subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD). METHODS: Clinical and genetic data from 12 datasets were examined. Global cognition was assessed using the Mattis Dementia Rating Scale (MDRS). Subjects were examined for mutations in GBA and categorized as GBA carriers with or without DBS (GBA+DBS+, GBA+DBS-), and non-carriers with or without DBS (GBA-DBS+, GBA-DBS-). GBA mutation carriers were subcategorized according to mutation severity (risk variant, mild, severe). Linear mixed modeling was used to compare rate of change in MDRS scores over time among the groups according to GBA and DBS status and then according to GBA severity and DBS status. RESULTS: Data were available for 367 subjects: 58 GBA+DBS+, 82 GBA+DBS-, 98 GBA-DBS+, and 128 GBA-DBS- subjects who were longitudinal followed (range 36 to 60 months after surgery). Using the MDRS, GBA+DBS+ subjects declined on average 2.02 points/year more than GBA-DBS- subjects (95% CI = -2.35, -1.69), 1.71 points/year more than GBA+DBS- subjects (95% CI = -2.14, -1.28), and 1.49 points/year more than GBA-DBS+ subjects (95% CI = -1.80, -1.18). INTERPRETATION: Although non-randomized, this composite analysis suggests that the combined effects of GBA mutations and STN-DBS negatively impact cognition. We advise that DBS candidates be screened for GBA mutations as part of the pre-surgical decision-making process. We advise that GBA mutation carriers be counseled regarding potential risks associated with STN-DBS and alternative options may be considered. This article is protected by copyright. All rights reserved.

Type: Article
Title: Parkinson disease and STN-DBS: cognitive effects in GBA mutation carriers
Location: United States
DOI: 10.1002/ana.26302
Publisher version: https://doi.org/10.1002/ana.26302
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences
URI: https://discovery.ucl.ac.uk/id/eprint/10141715
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