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. 2022 Jun 9;12(6):759.
doi: 10.3390/brainsci12060759.

Nomogram to Predict Cognitive State Improvement after Deep Brain Stimulation for Parkinson's Disease

Bowen Chang  1   2 , Chen Ni  1   2 , Weiwen Zhang  1   2 , Jiaming Mei  1   2 , Chi Xiong  1   2 , Peng Chen  1   2 , Manli Jiang  1   2 , Chaoshi Niu  1   2
Affiliations

Nomogram to Predict Cognitive State Improvement after Deep Brain Stimulation for Parkinson's Disease

Bowen Chang et al. Brain Sci. .

Abstract

Purpose: Parkinson's disease (PD) is a common neurodegenerative disease, for which cognitive impairment is a non-motor symptom (NMS). Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for PD. This study established a nomogram to predict cognitive improvement rate after STN-DBS in PD patients.

Methods: We retrospectively analyzed 103 PD patients who underwent STN-DBS. Patients were followed up to measure improvement in MoCA scores one year after surgery. Univariate and multivariate logistic regression analyses were used to identify factors affecting improvement in cognitive status. A nomogram was developed to predict this factor. The discrimination and fitting performance were evaluated by receiver operating characteristics (ROC) analysis, calibration diagram, and decision curve analysis (DCA).

Results: Among 103 patients, the mean improvement rate of the MoCA score was 37.3% and the median improvement rate was 27.3%, of which 64% improved cognition, 27% worsened cognition, and 8.7% remained unchanged. Logistic multivariate regression analysis showed that years of education, UPDRSIII drug use, MoCA Preop, and MMSE Preop scores were independent factors affecting the cognitive improvement rate. A nomogram model was subsequently developed. The C-index of the nomogram was 0.98 (95%CI, 0.97-1.00), and the area under the ROC was 0.98 (95%CI 0.97-1.00). The calibration plot and DCA demonstrated the goodness-of-fit between nomogram predictions and actual observations.

Conclusion: Our nomogram could effectively predict the possibility of achieving good cognitive improvement one year after STN-DBS in patients with PD. This model has value in judging the expected cognitive improvement of patients with PD undergoing STN-DBS.

Keywords: Parkinson’s disease; cognitive state; deep brain stimulation; nomogram; non-motor symptoms.

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Conflict of interest statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Figure 1
Figure 1
Comparison of MoCA score between pre-operation and one year after operation.
Figure 2
Figure 2
Comparison of details of MoCA score between preoperative and postoperative one year. ** p < 0.01.
Figure 3
Figure 3
Correlations of MoCA score improvement rate with MoCA preop (A), education (B), MMSE preop (C) and UPDRSIII drug on (D).
Figure 4
Figure 4
Nomogram to predict improvement of MoCA score after STN-DBS for PD. Clinical factor corresponds to a specific point by drawing a line straight upward to the points axis. After the sum of the points is located on the total points axis, the sum represents the probability of obtaining higher a MoCA score improvement rate. * p < 0.01, *** p < 0.001.
Figure 5
Figure 5
A receiver operating characteristic curve to evaluate the discriminating capability of the nomogram.
Figure 6
Figure 6
Calibration curve of the model. The calibration of the model in line with the agreement between predicted and observed outcomes of improvement of MoCA score.
Figure 7
Figure 7
The decision curve analysis diagram of the model.
See this image and copyright information in PMC

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