The white matter hyperintensities within the cholinergic pathways and cognitive performance in patients with Parkinson's disease after bilateral STN DBS

Abstract

Background: White matter hyperintensities (WMHs) in the cholinergic pathways are associated with cognitive impairment in Parkinson's disease (PD). This study aimed to investigate the role of WMHs within the cholinergic pathways in cognitive performance following bilateral subthalamic nucleus deep brain stimulation (STN DBS) in patients with PD.

Methods: 38 patients with PD who underwent bilateral STN DBS were assessed using the Cholinergic Pathways Hyperintensities Scale (CHIPS) with magnetic resonance imaging before surgery. Their cognitive statuses were evaluated pre-surgically and 6 months, 1 year, and 2 years post operation. The correlations between the CHIPS score and cognitive performance were analyzed. The differences in cognitive performance before and after the surgery between the high-CHIPS and low-CHIPS groups were also compared.

Results: The CHIPS score in patients with PD negatively correlated with the general cognition assessed using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) both at baseline and after DBS. No correlation was found between the CHIPS score and the change of MMSE and MoCA scores after DBS. No significant difference was observed in the change in cognitive performance after the surgery between the high and low-CHIPS groups.

Conclusion: The severity of cholinergic WMHs was correlated with the cognition in patients with PD both before and after the STN DBS. However, it does not correlate with the cognitive change in patients with PD after bilateral STN-DBS.

Keywords: Cholinergic pathways hyperintensities; Cholinergic pathways hyperintensities scale; Cognition; Parkinson's disease; Subthalamic nucleus deep brain stimulation.