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. 2025 Aug;15(5):998-1006.
doi: 10.1177/1877718X251354933. Epub 2025 Jun 26.

Depressive symptoms can negatively influence patient reported disease severity after subthalamic nucleus stimulation for Parkinson's disease

Christine Girges  1   2 , Alexis de Roquemaurel  3 , Nirosen Vijiaratnam  4   5 , Jennifer Foley  1   6 , Joseph Candelario  1   2 , Maricel Salazar  1   2 , Catherine Milabo  1   2 , John Esperida  1   2 , Tim Grover  1   2 , Harith Akram  1   2 , Jonathan Hyam  1   2 , Marie T Krüger  1   2   7 , Ludvic Zrinzo  1   2 , Patricia Limousin  1   2 , Thomas Foltynie  1   2
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Free article

Depressive symptoms can negatively influence patient reported disease severity after subthalamic nucleus stimulation for Parkinson's disease

Christine Girges et al. J Parkinsons Dis. 2025 Aug.
Free article

Abstract

BackgroundDepression can negatively influence an individual's perception of their disease. Although subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for Parkinson's disease (PD), some patients do not appreciate benefits despite showing objective improvements in motor function.ObjectiveWe explored the impact of depressive symptoms on self-reported outcomes of PD severity in patients who underwent STN-DBS.MethodsAssessments took place preoperatively and 2-years after surgery. Patients completed the Hospital Anxiety and Depression Scale (HADS), Unified Parkinson's Disease Rating Scale (UPDRS) Parts 2 and 4, Gait and Falls Questionnaire, Parkinson's Disease Questionnaire-39 (PDQ-39), and the Non-motor Symptoms Scale. The UPDRS Part 3 (motor examination) was also performed. Patients were dichotomized into two groups (normal or high) based on their postoperative follow-up HADS depression score.ResultsEighteen patients (33.3%) were assigned to the high group (hHADS-D), and 36 patients (66.7%) were assigned to the normal group (nHADS-D). The UPDRS Part 3 OFF-medication score improved to a similar extent in both groups, and participants experienced a similar reduction in their levodopa equivalent daily dose following STN-DBS. Unlike the nHADS-D group, however, hHADS-D patients did not self-report improvements on any clinical outcome measure at follow-up from baseline, and instead indicated a significant worsening on the UPDRS Part 2 ON-medication and PDQ-39 cognition domain. This was not explicable by their preoperative non-motor symptom burden, nor changes in dopaminergic medications. There were no differences between groups in terms of proportion using anti-depressants, surgical complications or postoperative side effects.ConclusionsDepressive symptoms may play a significant role in subjective self-reporting, and should be carefully considered when evaluating STN-DBS effectiveness and managing patients postoperatively.

Keywords: Parkinson's disease; deep brain stimulation; depressive symptoms; outcome measures.

Plain language summary

Feeling low can affect our outlook, meaning we may pay less attention to positive events and interpret certain situations more pessimistically. Deep brain stimulation (DBS) is a surgical treatment for Parkinson's disease (PD), and helps to improve motor symptoms (e.g., tremor, stiffness and slowness) and consequently quality of life. Some people with PD, however, do not feel that this treatment has helped them. We therefore explored the impact of depressive symptoms on self-reported questionnaires, measuring the patients’ own perception and experience of their disease two years following DBS surgery. Fifty-four people with PD were divided into two groups (normal or high burden of depression) based on a score from a self-reported questionnaire which primarily assessed anhedonia (loss of pleasure). We found the groups to be comparable in terms of how long they experienced PD for and how severe the motor symptoms were when assessed by a doctor. The extent of their motor symptom improvement and dopaminergic medication reduction were also similar after surgery, as were the number of side effects experienced by each group and the number of adjustments needed to optimize the treatment. However, the high depression group did not report improvements in their quality of life, walking and balance, and non-motor symptoms (such as memory, sleep and constipation). Instead, they reported a significant worsening in their cognition and how PD impacted on their daily activities when medicated. These results thus suggest that depressive symptoms can negatively influence how a patient may judge their symptoms, and reinforces that it is important to identify and treat any low mood to improve outcomes following DBS.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JF has received grants from Parkinson's UK.MK is a consultant for Brainlab, Elekta and Boston Scientific and has received funding from Medtronic.LZ acts as a consultant for Medtronic, Boston Scientific, Insightec.PL acts as consultant for and has received honoraria for educational activities with Boston Scientific, Medtronic, Aleva and INBRAIN.TF has served on advisory boards for Voyager Therapeutics, Handl therapeutics, Living Cell Technologies, Bial, Profile Pharma. He has received grants from National Institute of Health Research, Michael J Fox Foundation, John Black Charitable Foundation, Cure Parkinson's Trust, Innovate UK, Van Andel Research Institute and Defeat MSA. He has received honoraria for talks sponsored by Bial, Profile Pharma, Boston Scientific.The remaining authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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