The UF Deep Brain Stimulation Cognitive Rating Scale (DBS-CRS): Clinical Decision Making, Validity, and Outcomes

Abstract

To more efficiently communicate the results of neuropsychological assessment to interdisciplinary teams, the University of Florida Neuropsychology Service developed a Deep Brain Stimulation-Cognitive Rating Scale (DBS-CRS). This tool condensed results of a 3-h exam into a five-point scale ranging from 1 (least) to 5 (most) cognitive concern for DBS surgery. In this study, we evaluated the role of the DBS-CRS in clinical decisions by the interdisciplinary team to proceed to surgery, its relationship to objective neuropsychological scores, and its predictive utility for clinical outcome. We retrospectively examined 189 patients with Parkinson’s disease who were evaluated for DBS candidacy (mean age 64.8 [ SD 9.2], disease duration 8.9 years [ SD 5.0], UPDRS-Part III off medication 38.5 [ SD 10.5], Dementia Rating Scale-II 135.4 [ SD 6.0]). Approximately 19% of patients did not proceed to surgery, with neuropsychological red flags being the most commonly documented reason (57%). Patients who underwent DBS surgery had significantly better DBS-CRS scores than those who did not ( p < 0.001). The two strongest and unique neuropsychological contributors to DBS-CRS ratings were delayed memory and executive function, followed by language and visuoperception, based on hierarchical linear regression that accounted for 77.2% of the variance. In terms of outcome, DBS-CRS scores were associated with higher quality of life, less severe motor symptoms, and better daily functioning 6 months following DBS surgery. Together, these findings support the construct and predictive validity of the DBS-CRS as a concise tool for effectively communicating pre-DBS cognitive concerns to an interdisciplinary team, thereby aiding decision making in potential DBS candidates.

Cognitive and quality‐of‐life related factors of body mass index (BMI) improvement after deep brain stimulation in the subcallosal cingulate and nucleus accumbens in treatment‐refractory chronic anorexia nervosa

“…Future research should consider larger samples and more extended follow‐up periods better to understand the long‐term effects of DBS on these variables. A standardized neuropsychological assessment for patients with psychiatric illnesses undergoing DBS might be helpful to compare findings from different studies (Kenney et al., 2020). The findings reported here are promising and provide relevant evidence about the safety of DBS for neuropsychological functions and its potential benefits in memory and cognitive flexibility, thus presenting DBS as a promising alternative to conventional interventions for AN.…”

Global Variability in Deep Brain Stimulation Practices for Parkinson’s Disease

“…Furthermore, 12.2% of respondents did not require neuropsychological evaluation, with 46.2% if deficits were uncovered mandating a conditional neuropsychological evaluation after a cognitive screening examination ( Rothlind et al, 2015 ; Cernera et al, 2019 ; Kenney et al, 2020 ). The literature is evolving but supportive of the notion that brain target selection can impact cognitive or and mood outcomes following DBS ( Okun et al, 2009 ; Rothlind et al, 2015 ; Kenney et al, 2020 ) and that baseline cognitive performance predicts post-DBS cognitive decline and quality of life ( Odekerken et al, 2015 ; Kenney et al, 2020 ). The survey revealed room for potential improvement in utilizing multidisciplinary teams with patient-centered assessments, including neuropsychological and psychosocial function, rather than relying on strict rating scale cut-offs, permitting more inclusiveness for patients who may benefit from DBS.…”

“…However, only half of the respondents reported using a multidisciplinary committee to determine DBS candidacy. Furthermore, 12.2% of respondents did not require neuropsychological evaluation, with 46.2% if deficits were uncovered mandating a conditional neuropsychological evaluation after a cognitive screening examination (Rothlind et al, 2015;Cernera et al, 2019;Kenney et al, 2020). The literature is evolving but supportive of the notion that brain target selection can impact cognitive or and mood outcomes following DBS (Okun et al, 2009;Rothlind et al, 2015;Kenney et al, 2020) and that baseline cognitive performance predicts post-DBS cognitive decline and quality of life (Odekerken et al, 2015;Kenney et al, 2020).…”

Patients with Cognitive Impairment in Parkinson's Disease Benefit from Deep Brain Stimulation: A Case‐Control Study

“…Standards for clinical improvements after DBS and rates of complications have been established largely from controlled clinical trials; however, these studies only included patients with normal or mildly impaired cognition frequently defined by total Mattis Dementia Rating Scale (DRS‐2) 18 score above 130 19–21 . Mild cognitive impairment (MCI) is prevalent in the PD population, and most patients undergoing DBS have some form of MCI 22 . Patients with MCI have been shown to functionally benefit from DBS, although certain cognitive deficits may predict prolonged hospitalization 23 .…”

“…[19][20][21] Mild cognitive impairment (MCI) is prevalent in the PD population, and most patients undergoing DBS have some form of MCI. 22 Patients with MCI have been shown to functionally benefit from DBS, although certain cognitive deficits may predict prolonged hospitalization. 23 Whether a single test such as DRS-2 can predict DBS outcome has been controversial.…”