Caregiver Burden in Patients with Parkinson Disease Undergoing Deep Brain Stimulation: An Exploratory Analysis

Abstract

Background: Little is known about caregiver burden in Parkinson disease (PD) patients undergoing brain stimulation (DBS) surgery.Objective: The aim of this exploratory analysis was to evaluate whether caregiver burden improves after bilateral subthalamic nucleus (STN) DBS for PD patients and identify baseline factors associated with caregiver burden. Methods: We analyzed the motor, cognitive and behavioral data of 12 PD patients (9 men/3 women) who underwent bilateral STN DBS and whose caregivers completed the Caregiver Burden Inventory (CBI) both before and approximately 6 months after bilateral STN DBS. Results: Total CBI score did not change from baseline (17.8 ± 10.7) to the 6 month evaluation (18.7 ± 13.1), despite a 29% improvement in the MDS-UPDRS motor score (baseline 40.3 ± 12.1 compared to 28.7 ± 8.4 at 6 months, p = 0.01). Change in total CBI score did not correlate with change in MDS-UPDRS Parts I-IV or MoCA from baseline to 6 months. In post-hoc analyses looking at baseline characteristics that may correlate with caregiver burden, only the disinhibition subscore on the Frontal Systems Behavioral Scale correlated positively with the baseline total CBI score (ρ = 0.763, p = 0.004). Conclusion: Caregiver burden for PD patients (as measured by the CBI) does not change 6 months after bilateral STN DBS, despite significant improvement in motor function. Only baseline behavioral problems, specifically disinhibition, correlated with higher baseline caregiver burden. Clinicians may need to better counsel patients on expectations for caregiver burden after DBS.

Minimal clinically important differences for the experiences of daily living parts of movement disorder society–sponsored unified Parkinson's disease rating scale

“…Numerous studies utilized the MDS‐UPDRS Parts I and II, as outcome measures. Studies demonstrating the efficacy of exenatide, DBS, and levodopa/carbidopa intestinal gel therapy met the criterion of clinical relevance by exceeding our MCID thresholds. Additionally, we identified two studies in which the achieved improvement did not meet the requirements for clinical importance .…”

Belastungen in der Betreuung von Parkinson-Patientinnen und - Patienten

“…Hinsichtlich der Bedeutung medikamentöser und invasiver Therapien auf die Betreuungsbelastung finden sich in der Literatur einerseits der Faktor Dosis der dopaminergen Therapie als Ausdruck der Krankheitsdauer und des Schweregrades der motorischen Symptomatik des Pfleglings als ein Belastungsfaktor [12,33,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50], andererseits einige medikamentöse Therapien, wie die Levodopa/Carbidopa intestinale Geltherapie (Duodopa), zu der in nichtkontrollierten Studien teilweise positive Effekte auf die Betreuungsbelastung festgestellt wurden [38,39] und die Palliativ-Betreuung [19,20,32]. Außerdem wurde in kontrollierten Therapiestudien mit Memantin und Donepezil bei Personen mit Parkinson-Demenz und Demenz mit Lewy-Körperchen sowie mit Rivastigmin bei apathischen depressions-und demenzfreien Parkinson-Pat.…”

“…Die tiefe Hirnstimulation kann zwar die Lebensqualität von Pat. verbessern, Belastungen für Betreuungspersonen scheinen sich laut jüngeren Studien aber nicht reduzieren lassen [40][41][42]45]. Neurokognitive Beeinträchtigungen [34,[52][53][54][55] Neuropsychiatrische Symptome, wie Depression, Angst, Apathie, Mangel an Empathie, Aggression, Halluzinationen und Impuls-Kontrollstörungen [15,33,[55][56][57][58][59][60] Nächtliche Symptome, inklusive Pollakisurie und Inkontinenz [61,62] Schlafstörungen [15,36] Autonome Störungen (z.B.…”

Caregiver Burden and Caregiver Appraisal of Psychiatric Symptoms are not Modulated by Subthalamic Deep Brain Stimulation for Parkinson’s Disease

“…However, our sample size is larger than comparable investigations employing such detailed phenotypic characterisation 14,17,18 and our calculation suggests our study is adequately powered to meet our primary objective. Additionally, the participants in our investigation are similar in terms of clinical severity, demographics and prior treatment to other large neurosurgical centres.…”