Predictors of short-term anxiety outcome in subthalamic stimulation for Parkinson’s disease
Authors: Sauerbier Anna , Herberg Johanna , Stopic Vasilija , Loehrer Philipp A. , Ashkan Keyoumars , Rizos Alexandra , Jost Stefanie T. , Petry-Schmelzer Jan Niklas , Gronostay Alexandra , Schneider Christian , Visser-Vandewalle Veerle , Evans Julian , Nimsky Christopher , Fink Gereon R. , Antonini Angelo , Martinez-Martin Pablo , Silverdale Monty , Weintraub Daniel , Schrag Anette , Ray Chaudhuri K. , Timmermann Lars , Dafsari Haidar S. ,   EUROPAR, the German Parkinson Society Non-motor Symptoms Study Group, and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group, Adler Charles , Bhidayasiri Roongroj , Borghammer Per , Barone Paolo , Brooks David J. , Brown Richard , Cantillon Marc , Carroll Camille , Coelho Miguel , Falup-Pecurariu Cristian , Henriksen Tove , Hu Michele , Jenner Peter , Jeon Beomseok , Kramberger Milica , Kumar Padma , Kurtis Mónica , Leta Valentina , Lewis Simon , Litvan Irene , Lyons Kelly , Martino Davide , Masellis Mario , Mochizuki Hideki , Morley James F. , Nirenberg Melissa , Odin Per , Pagonabarraga Javier , Panicker Jalesh , Pavese Nicola , Pekkonen Eero , Postuma Ron , Rodriguez Violante Mayela , Rosales Raymond , Schapira Anthony , Simuni Tanya , Stocchi Fabrizio , Storch Alexander , Subramanian Indu , Tagliati Michele , Tinazzi Michele , Toledo Jon , Tsuboi Yoshio , Walker Richard 
Published: June 2024

The effects of subthalamic nucleus deep brain stimulation (STN-DBS) on anxiety in Parkinson’s disease (PD) are understudied. We identified clinical predictors of STN-DBS effects on anxiety in this study. In this prospective, open-label, multicentre study, we assessed patients with anxiety undergoing STN-DBS for PD preoperatively and at 6-month follow-up postoperatively. We assessed the Hospital Anxiety and Depression Scale (HADS-anxiety and depression subscales), Unified PD Rating Scale-motor examination, Scales for Outcomes in PD-motor (SCOPA-M)-activities of daily living (ADL) and -motor complications, Non-Motor Symptom Scale (NMSS), PDQuestionnaire-8 (PDQ-8), and levodopa-equivalent daily dose. We tested changes at follow-up with Wilcoxon signed-rank test and corrected for multiple comparisons (Bonferroni method). We identified patients with a clinically relevant anxiety improvement of anxiety based on a designated threshold of ½ standard deviation of baseline HADS-anxiety. Moreover, we investigated predictors of HADS-anxiety changes with correlations and linear regressions. We included 50 patients with clinically relevant baseline anxiety (i.e., HADS-anxiety ≥ 8) aged 63.1 years ± 8.3 with 10.4 years ± 4.5 PD duration. HADS-anxiety improved significantly at 6-month follow-up as 80% of our cohort experienced clinically relevant anxiety improvement. In predictor analyses, worse baseline SCOPA-ADL and NMSS-urinary domain were associated with greater HADS-anxiety improvements. HADS-anxiety and PDQ-8 changes correlated moderately. Worse preoperative ADL and urinary symptoms predicted favourable postoperative anxiety outcome, which in turn was directly proportionate to greater QoL improvement. This study highlights the importance of detailed anxiety assessments alongside other non-motor and motor symptoms when advising and monitoring patients undergoing STN-DBS for PD.