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Cognitive declines after deep brain stimulation are likely to be attributable to more than caudate penetration and lead location

Takashi Morishita, Michael S. Okun, Jacob D. Jones, Kelly D. Foote, Dawn Bowers
DOI: http://dx.doi.org/10.1093/brain/awu008 e274 First published online: 11 February 2014

Sir, We have read the follow-up paper from the German multi-centre randomized deep brain stimulation (DBS) trial (Witt et al., 2013) with great interest. The authors conducted a study investigating the relationship between DBS lead trajectory and cognitive decline after surgery performed in patients with Parkinson’s disease. They concluded that penetration of the caudate nucleus was a risk factor for global cognitive decline, and that suboptimal placement of the electrode outside of the subthalamic nucleus (STN) also increased the risk of verbal fluency decline. These were interesting findings, however, we strongly suspect that these two issues make up only a subset of what is likely multiple factors affecting DBS cognitive outcome. The pathophysiology of cognitive decline in Parkinson’s disease is complex, and cognitive decline after STN DBS may be affected by baseline cognitive dysfunction, brain atrophy, and by surgical complications (e.g. intracranial haemorrhage).

To more closely examine this issue, …

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