Incidence and Risk Factors of Postoperative Neuropsychiatric Dysfunctions after Deep Brain Stimulation Surgery in Patients with Parkinson’s Disease: A Prospective Cohort Study

Objective To investigate the incidence of postoperative neuropsychic dysfunction (PND) in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) and to analyze its influencing factors. Methods A prospective study was conducted, recruiting PD patients from the Functional Neurosurgery Outpatient Clinic of Beijing Tiantan Hospital, Capital Medical University, between January 2020 and December 2022. All patients were scheduled to undergo bilateral subthalamic nucleus (STN)-DBS surgery. Perioperative clinical data were collected, and PND (outcome measure) within 3 days postoperatively was assessed using the Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), Hamilton depression and anxiety scales, and 3-minute diagnostic interview for confusion assessment method (3D-CAM). Multivariate Logistic regression was used to analyze the influencing factors of PND. Results A total of 216 PD patients were enrolled. Within 3 days after DBS surgery, 77 patients (33.8%) developed PND, including 24 cases (31.2%) of depression or worsening depression, 16 cases (20.8%) of anxiety or worsening anxiety, 13 cases (16.9%) of cognitive decline, and 24 cases (31.2%) of delirium. Univariate analysis revealed that dural opening method, dural opening time, intraoperative improvement rate of the unified Parkinson's disease rating scale part III (UPDRS-III) score, and postoperative intracranial air volume were significantly different between PND and non-PND patients (all P < 0.05). Multivariate Logistic regression analysis showed that female sex (OR = 2.468, 95% CI: 1.077– 5.657, P = 0.033) and postoperative intracranial air volume (OR = 1.214, 95% CI: 1.117–1.320, P < 0.001) were independent risk factors for PND, while a higher intraoperative UPDRS-III improvement rate was a protective factor (OR = 0.895, 95% CI: 0.865–0.925, P < 0.001). Conclusions PD patients have a high incidence of PND after DBS surgery. Sex, postoperative intracranial air volume, and the degree of improvement in PD motor symptoms can influence the risk of PND. These findings highlight the importance of individualized management based on sex, improving surgical techniques, and enhancing monitoring of neuropsychiatric status to optimize the efficacy of DBS surgery.