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Hippocampal atrophy predicts conversion to dementia after STN-DBS in Parkinson's disease

Aybek, Selma
Gronchi-Perrin, Aline
Published in Parkinsonism & related disorders. 2009, vol. 15, no. 7, p. 521-524
Abstract BACKGROUND: Hippocampal atrophy (HA) is a known predictor of dementia in Alzheimer's disease. HA has been found in advanced Parkinson's disease (PD), but no predicting value has been demonstrated yet. The identification of such a predictor in candidates for subthalamic deep brain stimulation (STN-DBS) would be of value. Our objective was to compare preoperative hippocampal volumes (HV) between PD patients who subsequently converted to dementia (PDD) after STN-DBS and those who did not (PDnD). METHODS: From a cohort of 70 consecutive STN-DBS treated PD patients, 14 converted to dementia over 25.6+/-20.2 months (PDD). They were compared to 14 matched controls (PDnD) who did not convert to dementia after 43.9+/-11.7 months. On the preoperative 3D MPRAGE MRI images, HV and total brain volumes (TBV) were measured by a blinded investigator using manual and automatic segmentation respectively. RESULTS: PDD had smaller preoperative HV than PDnD (1.95+/-0.29 ml; 2.28+/-0.33 ml; p<0.01). This difference reinforced after normalization for TBV (3.28+/-0.48, 3.93+/-0.60; p<0.01). Every 0.1 ml decrease of HV increased the likelihood to develop dementia by 24.6%. A large overlap was found between PD and PDnD HVs, precluding the identification of a cut-off score. CONCLUSIONS: As in Alzheimer's disease, HA may be a predictor of the conversion to dementia in PD. This preoperative predictor suggests that the development of dementia after STN-DBS is related to the disease progression, rather then the procedure. Further studies are needed to define a cut-off score for HA, in order to affine its predictive value for an individual patient.
Keywords AgedAtrophy/complications/etiology/pathologyCase-Control StudiesCohort StudiesDeep Brain Stimulation/*adverse effectsDementia/*etiologyFemaleHippocampus/*pathologyHumansImaging, Three-Dimensional/methodsLogistic ModelsMagnetic Resonance Imaging/methodsMaleMental Status ScheduleMiddle AgedParkinson Disease/therapyPredictive Value of TestsSeverity of Illness Index
PMID: 19349206
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Research groups Groupe Lazeyras Francois (IRM fonctionnelle et métabolique) (539)
Groupe Pierre Burkhard (neurologie) (154)
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AYBEK, Selma et al. Hippocampal atrophy predicts conversion to dementia after STN-DBS in Parkinson's disease. In: Parkinsonism & related disorders, 2009, vol. 15, n° 7, p. 521-524. doi: 10.1016/j.parkreldis.2009.01.003 https://archive-ouverte.unige.ch/unige:19652

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Deposited on : 2012-04-23

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