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. 2024;14(6):1175-1192.
doi: 10.3233/JPD-230276.

Risk Factors for Postoperative Delirium Severity After Deep Brain Stimulation Surgery in Parkinson's Disease

Melanie Astalosch  1   2 , Mahta Mousavi  3 , Luísa Martins Ribeiro  1   4 , Gerd-Helge Schneider  5 , Heiner Stuke  6   7   8 , Stefan Haufe  3   7   9 , Friedrich Borchers  4 , Claudia Spies  4 , Judith von Hofen-Hohloch  10 , Bassam Al-Fatly  1 , Georg Ebersbach  11 , Christiana Franke  2 , Andrea A Kühn  1   12   13 , Dorothee Kübler-Weller  1   2
Affiliations

Risk Factors for Postoperative Delirium Severity After Deep Brain Stimulation Surgery in Parkinson's Disease

Melanie Astalosch et al. J Parkinsons Dis. 2024.

Abstract

Background: Postoperative delirium (POD) is a serious complication following deep brain stimulation (DBS) but only received little attention. Its main risk factors are higher age and preoperative cognitive deficits. These are also main risk factors for long-term cognitive decline after DBS in Parkinson's disease (PD).

Objective: To identify risk factors for POD severity after DBS surgery in PD.

Methods: 57 patients underwent DBS (21 female; age 60.2±8.2; disease duration 10.5±5.9 years). Preoperatively, general, PD- and surgery-specific predictors were recorded. Montreal Cognitive Assessment and the neuropsychological test battery CANTAB ConnectTM were used to test domain-specific cognition. Volumes of the cholinergic basal forebrain were calculated with voxel-based morphometry. POD severity was recorded with the delirium scales Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and Nursing Delirium Scale (NU-DESC). Spearman correlations were calculated for univariate analysis of predictors and POD severity and linear regression with elastic net regularization and leave-one-out cross-validation was performed to fit a multivariable model.

Results: 21 patients (36.8%) showed mainly mild courses of POD following DBS. Correlation between predicted and true POD severity was significant (spearman rho = 0.365, p = 0.001). Influential predictors were age (p < 0.001), deficits in attention and motor speed (p = 0.002), visual learning (p = 0.036) as well as working memory (p < 0.001), Nucleus basalis of Meynert volumes (p = 0.003) and burst suppression (p = 0.005).

Conclusions: General but also PD- and surgery-specific factors were predictive of POD severity. These findings underline the multifaceted etiology of POD after DBS in PD. Valid predictive models must therefore consider general, PD- and surgery-specific factors.

Keywords: Parkinson’s disease; cognition; deep brain stimulation; outcome; personalized therapy; postoperative delirium; risk prediction.

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Conflict of interest statement

GHS reports honoraria for lectures by Medtronic, Boston Scientific and Abbott. CS reports public grants from German Research Society, DLR, Einstein Foundation Berlin, G-BA, Inner University Grants, Project Management Agency, Non-Profit Society Promoting Science and Education, European Siciety of Anaesthesiology and Intensive Care, BMWI, Georg Thieme Verlag, Dr. F. Köhler Chemie GmbH, Sintetica GmbH, Max-Planck-Gesellschaft zur Förderung von Wissenschaften e.V., Metronic, Philips Electronics Nederland BV, RKI, BMBF and nonfinancial support from AWMF and Leopoldina. GE reports honoraria from AbbVie Pharma, BIAL Pharma, Desitin Pharma, STADA Pharma, ESTEVE Pharma, Neuraxpharm GmbH, Boehringer GmbH, speakers honorary from AbbVie Pharma, BIAL Pharma, Britannia Pharma, Desitin Pharma, ESTEVE Pharma, Licher GmbH, STADA Pharma, Zambon Pharma and Royalties from Kohlhammer Verlag, Thieme Verlag. AAK reports honoraria and non-financial support from Medtronic, honoraria from Boston Scientific, Ipsen Pharma and Abbott. DKW reports reports honoraria for lectures from BIAL Pharma and STADA Pharma. MA, MM, LMR, HS, SH, FB, JHH, BAF and CF have nothing to disclose.

Figures

Fig. 1
Fig. 1
Visualization of electrode locations of the POD– (blue electrodes) and POD+ group (red electrodes). Dark red: red nucleus; orange: STN; green: Globus pallidus internus (GPi); blue: Globus pallidus externus (GPe).
Fig. 2
Fig. 2
Intraoperative EEG power spectra (average of the normalized power across the 4 channels) with 95% confidence interval, group comparison between POD+ (red) and POD– (blue).
Fig. 3
Fig. 3
Correlation between true and predicted POD severity from the regularized regression. POD+ (red) and POD– (blue). For illustration purposes of the model fit, an x = y line was plotted.
See this image and copyright information in PMC

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