Patients with Parkinson's disease had similar improvement in motor function after either pallidal or subthalamic stimulation. Nonmotor factors may reasonably be included in the selection of surgical target for deep-brain stimulation. (ClinicalTrials.gov numbers, NCT00056563 and NCT01076452.)

This study provides Class III evidence that improvement of motor symptoms of PD by DBS remains stable over 3 years and does not differ by surgical target. Neurology® 2012;79:55-65.

Objective As no comprehensive assessment instrument for impulse control disorders (ICDs) in Parkinson’s disease (PD) exists, the aim of this study was to design and assess the psychometric properties of a self-administered screening questionnaire for ICDs and other compulsive behaviors in PD. Methods The Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) has 3 sections: Section 1 assesses four ICDs (involving gambling, sexual, buying, and eating behaviors), Section 2 other compulsive behaviors (punding, hobbyism and walkabout), and Section 3 compulsive medication use. For validation, a convenience sample of 157 PD patients at 4 movement disorders centers first completed the QUIP, and then was administered a diagnostic interview by a trained rater blinded to the QUIP results. A shortened instrument (QUIP-S) was then explored. Results The discriminant validity of the QUIP was high for each disorder or behavior (receiver operating characteristic area under the curve [ROC AUC]: gambling=0.95, sexual behavior=0.97, buying=0.87, eating=0.88, punding=0.78, hobbyism=0.93, walkabout=0.79). On post hoc analysis, the QUIP-S ICD section had similar properties (ROC AUC: gambling=0.95, sexual behavior=0.96, buying=0.87, eating=0.88). When disorders/behaviors were combined, the sensitivity of the QUIP and QUIP-S to detect an individual with any disorder was 96% and 94%, respectively. Conclusions Scores on the QUIP appear to be valid as a self-assessment screening instrument for a range of ICDs and other compulsive behaviors that occur in PD, and a shortened version may perform as well as the full version. A positive screen should be followed by a comprehensive, clinical interview to determine the range and severity of symptoms, as well as need for clinical management.

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SETTING-Two movement disorders centers at the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center.PARTICIPANTS-A convenience sample of 131 patients with idiopathic PD who were screened for cognitive and psychiatric complications.MEASUREMENTS-Subjects were administered the MoCA and MMSE, and only subjects defined as having a normal age-and education-adjusted MMSE score were included in the analyses (N = 100). As previously recommended in patients without PD, a MoCA score less than 26 was used to indicate the presence of at least mild cognitive impairment (MCI). RESULTS-Mean MMSE andMoCA scores ± standard deviation were 28.8 ± 1.1 and 24.9 ± 3.1, respectively. More than half (52.0%) of subjects with normal MMSE scores had cognitive impairment according to their MoCA score. Impairments were seen in numerous cognitive domains, including memory, visuospatial and executive abilities, attention, and language. Predictors of cognitive impairment on the MoCA using univariate analyses were male sex, older age, lower © 2009, The American Geriatrics Society Address correspondence to Daniel Weintraub, 3615 Chestnut St., Room 330, Philadelphia, PA 19104. E-mail: weintrau@mail.med.upenn.edu. Author Contributions: S.N., A.D.S., J.E.D., A.C., S.S.H., P.J.M., J.W., M.B.S., D.W.: study concept and design, acquisition of subjects and data, analysis and interpretation of data, preparation of data, and preparation of manuscript. T.T.H.: analysis and interpretation of data, preparation of manuscript data, and preparation of manuscript. Impairments in executive function, attention, visuospatial skills, and memory characterize the "typical" cognitive profile in PD, whereas language and praxis are thought to be relatively spared. 3,4,9 The memory impairment associated with PD is classically considered a retrieval deficit (i.e., subcortical memory profile) as opposed to an encoding deficit (i.e., cortical memory profile). NIH Public AccessThere is substantial overlap in the pattern of observed cognitive deficits in PD without dementia and PDD. Studies enrolling both groups of patients have shown qualitatively similar, but quantitatively greater, impairments in patients with PDD in executive function, visuospatial abilities, attention, and psychomotor skills. 10 In longitudinal studies of patients without dementia at baseline, verbal memory deficits 11 and executive or visuospatial impairments 12 have been shown to predict development of PDD on long-term follow-up.Given the aforementioned high prevalence of MCI in PD and its association with future development of dementia, it is important that patients with PD, even those with mild disease, be screened regularly for cognitive impairment. 12 An ideal cognitive screening instrument in PD should be brief, assess a range of cognitive domains, simple to administer, sensitive to the initial stage of cognitive impairment, and unaffected by motor impairment.Few screening instruments have been validated or developed to assess global cognition in PD. The Scales for Outco...