Delirium after Deep Brain Stimulation in Parkinson’s Disease

Abstract

Deep brain stimulation is a primary treatment method that improves motor and motor complications in patients with advanced Parkinson’s disease. Delirium is a common and serious complication following deep brain stimulation. However, the clinical attention toward this complication remains insufficient. Advanced age, cognitive decline, and the severity of the disease may all be risk factors for delirium. The presence of delirium may also affect cognitive function and disease prognosis. Neurotransmitters such as acetylcholine and dopamine may be involved in the occurrence of delirium. Furthermore, inflammation, the effects of microlesioning of local nuclei, and brain atrophy may also play roles in the onset of delirium. Nonpharmacological therapy appears to be the primary treatment for postoperative delirium in Parkinson’s disease. The current article reviews the pathogenesis, epidemiology, prognosis, and treatment of delirium following deep brain stimulation in Parkinson’s disease to help clinicians better understand this common complication and to prevent, identify, and treat it as soon as possible, as well as to provide more accurate treatment for patients.

Additional Benefit of Intraoperative Electroacupuncture in Improving Tolerance of Deep Brain Stimulation Surgical Procedure in Parkinsonian Patients

“…In the field of DBS [ 15 , 17 ], but also in craniotomies performed in awake patients [ 42 ], intraoperative assessment is often limited to scoring pain intensity on a one-dimensional scale or reporting adverse events. In humans, there are quantified scales to assess SB [ 44 , 52 ], but these are usually adapted to the context of everyday life, with questions regarding libido, feelings of pleasure, loss of weight, sleep quality, and social isolation, which are not adapted to the intraoperative context [ 53 , 54 ]. This was one of the reasons for using the ESAS and its sub-scores, suitable for the evaluation of an intervention and whose use has been validated, including outside the context of palliative care, in which ESAS was originally developed [ 40 ].…”

Deep brain stimulation for Parkinson’s disease and depression.

“…It usually resolves within a few days but can affect cognitive function and disease prognosis (see Li et al, 2021, for a review). It has been associated with larger ventricles, older age, longer disease duration, and more medical comorbidities (Strapasson et al, 2019) as well as greater cognitive impairment (Li et al, 2021). Permanent global cognitive decline is less common, affecting around 9.4% of patients with STN DBS (Aybek et al, 2007) and its risk factors include older age, particularly older than 70 years (Smeding et al, 2011), and greater cognitive impairment (Lang & Widner, 2002;Smeding et al, 2011).…”

Association between Baseline Cognitive Score and Postoperative Delirium in Parkinson’s Disease Patients following Deep Brain Stimulation Surgery

“…However, delirium is one of the most common neuropsychiatric complications following DBS surgery [6], occurring in approximately 22-42.6% of patients [7,8]. Postoperative delirium (POD) is an acute disorder of attention and cognition in elderly people that is common, serious, costly, under-recognized, and often fatal [9].…”