Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson’s disease

• DOI: 10.1093/brain/awad324
• Publication Date: 2023-10-03T17:10:05Z
• Authors: Matthieu Béreau; Astrid Kibleur; Mathieu Servant; Gautier Clément; Kathy Dujardin; Anne-Sophie Rolland; Thomas Wirth; Ouhaid Lagha-Bouk...; Jimmy Voirin; Marie des Neiges ...; Elodie Hainque; David Grabli; Alexandre Comte; Sophie Drapier; Franck Durif; Ana Marques; Alexandre Eusebio; Jean-Philippe Azulay; Caroline Giordana; Jean-Luc Houeto; Béchir Jarraya; David Maltete; Olivier Rascol; Tiphaine Rouaud; Mélissa Tir; Caroline Moreau; Teodor Danaila; Stéphane Prange; Laurent Tatu; Christine Tranchant; Jean-Christophe C...; David Devos; Stephane Thobois; Maxime Desmarets; Mathieu Anheim
• Keywords: Apathy; Subthalamic Nucleus

Abstract Postoperative apathy is a frequent symptom in Parkinson’s disease patients who have undergone bilateral deep brain stimulation of the subthalamic nucleus. Two main hypotheses for postoperative been suggested: (i) dopaminergic withdrawal syndrome relative to drug tapering; and (ii) direct effect chronic The primary objective our study was describe preoperative 1-year underwent We also aimed identify factors associated with considering: clinical phenotype; management; (iii) volume tissue activated within nucleus surrounding structures. investigated prospective cohort 367 before 1 year after assessed using Lille Apathy Rating Scale carried out systematic evaluation motor, cognitive behavioural signs. modelled 161 Lead-DBS toolbox analysed overlaps limbic parts Of patients, 94 (25.6%) exhibited apathy: 67 (18.2%) ‘de novo apathy’ 27 (7.4%) ‘sustained apathy’. observed disappearance 22 (6.0%) were classified as having ‘reversed Lastly, 251 (68.4%) had neither nor ‘no identified score [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.10, 1.22; P < 0.001], episodic memory free recall (OR 0.93; CI 0.88, 0.97; = 0.003) motor responsiveness 0.98; 0.96, 0.99; 0.009) apathy. showed that dose reduction Patients poorer fronto-striatal status higher action initiation subscore. In these worsened postoperatively despite significantly lower dopamine agonists (P 0.023), suggesting dopa-resistant benefited from psychostimulant part left 0.043), motivational Our results highlight need careful assessment components well executive functions order better prevent or manage