Self-Transcendence: Association with Spirituality in an Italian Sample of Terminal Cancer Patients.

Terminally ill cancer patients often experience demoralization and loss of dignity, which undermines their spiritual wellbeing, which could, however, be supported by the presence of other factors such as self-transcendence and religious coping strategies. To assess self-transcendence and religious coping strategies and how they influence spirituality, we studied 141 end-stage cancer patients (64.3% male; mean age 68.6 ± 14.6) with a Karnofsky Performance Status ≤ 50 and a life expectancy ≤ 4 months using the Self-Transcendence Scale, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-Sp-12), the Brief Religious COPE, and the Patient Dignity Inventory. To understand the effects of these variables on spirituality, hierarchical multiple regression was performed on FACIT-Sp-12. The final model predicted 67% of the variance in spiritual wellbeing. Demoralization was the strongest influencing factor (ß = -0.727, p < 0.001), followed by self-transcendence (ß = 0.256, p < 0.001), and positive religious coping (ß = 0.148, p < 0.05). This study suggests that self-transcendence and positive religious coping may be protective factors for spirituality in terminal cancer patients. These factors should be considered in treatment to promote spiritual wellbeing and improve patients' quality of life at the end of life.

Relationship between demoralization and quality of life in end-of-life cancer patients.

OBJECTIVE: To examine the relationship between demoralization and health-related quality of life (HRQoL) in a sample of end-of-life cancer patients with a life expectancy of 4 months or less undergoing palliative care, controlling for sociodemographic, clinical, and psychological variables. METHODS: Sociodemographic, clinical, and psychological data from 170 end-of-life cancer patients were collected using the following scales: Edmonton Symptom Assessment System for palliative care patients' symptoms; Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms; Functional Assessment of Cancer Therapy Scale - General Measure (FACT-G) for HRQoL; Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being for spirituality (FACIT-Sp); Demoralization Scale - Italian Version (DS-IT) for demoralization. RESULTS: The DS-IT showed that 51.8% of cancer patients were severely demoralized. In addition, 36.5% of the sample had clinically significant depressive symptoms and QoL was severely impaired (FACT-G). The result of regression analysis showed that demoralization (especially "Disheartenment" and "Sense of failure") was the strongest contributor for HRQoL, followed by ESAS_Lack of Well-Being and depression (PHQ-9), with the final model explaining 66% of the variance of the FACT-G. CONCLUSIONS: The results highlight a very high prevalence of severe demoralization in end-of life cancer patients. Moreover, demoralization was not only associated with patients' HRQoL, but it was also the most important contributing factor. This finding underscores the need to identify preventive or therapeutic psychological interventions that focus on preventing existential distress, and thus improve the QoL of dying patients in their last days of life.

From the First to the Second Wave of COVID-19: Anxiety, De-Pressive, and Post-Traumatic Stress Symptoms in the Italian Population.

In the early stages of the COVID-19 outbreak, high rates of clinically relevant anxiety, depression, and post-traumatic stress symptoms (PTSS) have been reported in the Italian population. The persistence of the pandemic and related restrictive measures highlight the need for a reassessment of psychopathological symptoms. The present longitudinal study consisted of two evaluations conducted during the two waves of infection. Participants were asked to complete the State-Trait Anxiety Inventory-Form Y1 (STAI Y1), the Beck Depression Inventory (BDI-II), and the PTSD Checklist for DSM-5 (PCL-5). There were no significant differences in depressive symptoms and PTSS scores reported by participants between T0 and T1, with single-case analysis revealing that in 71% and 69% of the participants, depressive symptoms and PTSS symptoms, respectively, remained stable during this period. On the contrary, mean scores comparison showed a significant decrease in anxiety levels, with 19% of participants in whom anxiety symptoms improved at single-case analysis. Taken together, these results suggest that depressive symptoms and PTSS not only occurred in a high percentage of participants but also tended to remain stable over time, thus warranting the importance of large-scale psychological screening and interventions to prevent the chronicization of these symptoms and their evolution to psychopathological disorders.

Traumatic experiences and somatoform dissociation in women with fibromyalgia.

Objective: Psychological factors like traumatic life events seem to affect the etiopathogenesis and the exacerbation of fibromyalgia (FM), a chronic widespread musculoskeletal pain syndrome. This Study investigated the prevalence of traumatic events, with a particular attention to the whole life span, and both psychoform and somatoform dissociation in patients with FM, compared with healthy controls (HC). In addition, the possible effects of traumatic events and dissociative experiences on FM symptoms have been analyzed. Method: Traumatic experiences, dissociative symptoms, and psychological distress were assessed in 99 consecutive patients with FM and 107 healthy women. Student t-tests for two independent samples were used to determine differences between the FM and HC groups. A hierarchical multiple regression analysis was used to explore the possible contribution of trauma and dissociation to FM symptoms. Results: Results revealed that the levels of both somatoform and psychoform dissociation were higher among patients with FM than HC (p < .001). Moreover, patients with FM experienced significantly more negative life events than HC (p < .001). Finally, the data suggested that the severity of FM disabilities was significantly predicted by the presence of depressive symptoms, somatoform dissociation, cumulative trauma, and educational level. The final Model explained 40% of the variance. Conclusions: Results suggest that the construct of somatoform dissociation could serve as a useful framework to improve our understanding of FM symptoms, and stressed the importance of evaluating the effects of multiple traumas in cumulative form because this has substantial implications for the evaluation and treatment of patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Personality matters: relationship between personality characteristics, spirituality, demoralization, and perceived quality of life in a sample of end-of-life cancer patients.

PURPOSE: Personality could be an interesting dimension to explore in end-of-life cancer patients, in order to investigate how personality affects quality of life. Thus, this study aimed to investigate the relationship among personality through the Big Five Inventory (BFI), spirituality, and demoralization and to explore their impact on their quality of life. METHODS: A sample of 210 end-of-life Italian cancer patients were assessed with the BFI, the Demoralization Scale (DS), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-SP-12), the Functional Assessment of Cancer Therapy Scale-General Measure (FACT-G), and the Karnofsky performance status. RESULTS: Correlational analysis highlighted a significantly negative relationship between extraversion and agreeableness traits and all the demoralization dimensions. On the other side, neuroticism trait was significantly and positively correlated with the Demoralization Scale (p < 0.01). To understand the impact of these variables on quality of life (FACT-G), we performed a hierarchical multiple regression: in the final model, demoralization remained the strongest contributing factor (ß = - 0.509, p < 0.001), followed by neuroticism (ß = - 0.175, p < 0.001), spirituality (ß = 0.163, p = 0.015), and Karnofsky index (ß = 0.115, p = 0.012). CONCLUSION: Our data underlined how both the neuroticism trait and demoralization are correlated with a worst health status in terminal cancer patients, whereas spirituality is a protective factor. The study of personality may allow to better understand the inner patient's experience and improve communication between patient and healthcare staff in order to build and apply better-tailored psychological treatment.

Alexithymia and professional quality of life in radiation oncology: The moderator effect of the professional profile.

BACKGROUND AND PURPOSE: Cancer care can be taxing. Alexithymia, a personality construct characterized by difficulties in identifying and describing feeling and emotions, an externally-oriented thinking style and scarcity of imagination and fantasy, is significantly correlated with higher levels of both secondary traumatic stress (STS) and burnout and lower levels of compassion satisfaction in medical professionals in radiation oncology. In this study, we aimed to assess the difference in professional quality of life (QoL) and the association with alexithymia in this multidisciplinary field depending on the specific profession (radiation/clinical oncologist, RO; medical physicist, MP; radiation therapist, RTT). MATERIAL AND METHODS: The study was conducted via an online questionnaire, receiving 1500 submissions between May and October 2018. Alexithymia was assessed via the Toronto Alexithymia Scale (TAS-20) and professional QoL was evaluated using the Professional Quality of Life Scale (ProQoL) version 5. Comparisons between the RO, RTT, and MP groups were performed by ANOVA or MANOVA, followed by Bonferroni corrected ANOVAs for continuous variables, and Pearson's chi-square test for categorical variables. The effect size was determined by calculating partial eta-squared (η2). RESULTS: Profession had a moderator role on the correlation between alexithymia and STS, with RO being at a higher risk than MP and RTT. Further, the results of this study demonstrate the relevant point prevalence of decreased well-being at work even for professional categories such as MP despite the more technical profile and reduced interaction with patients. CONCLUSIONS: This study demonstrates the importance of alexithymia as a factor contributing to decreased professional QoL amongst radiation oncology professionals. Alexithymic ROs are impacted to a higher extent compared to MPs and RTTs by the indirect exposure to patients suffering. It is worth addressing these observations in professional education, aiming to improve QoL for healthcare personnel.

Adherence to oral chemotherapy: Evidence from a randomised clinical trial.

OBJECTIVE: To evaluate the efficacy of a reinforcement message (RM) administered by a hospital pharmacist on adherence, through a randomised study involving patients undergoing oral chemotherapy from which an objective outcome measure and patients' subjective opinions were collected. A secondary aim was to detect which psychological or clinical factors influence adherence. METHODS: Forty patients were enrolled and randomised to an experimental group (EG) or a control group (CG). The EG received a 10-minute RM provided by a hospital pharmacist with a doctor and a nurse. The CG received the standard of care. To measure adherence, plasma drug concentration and subjective evaluation were taken during the visits, in addition to a psychological assessment (coping strategies, psychological distress and personality traits). RESULTS: The EG reported higher drug levels and a statistically significant higher mean score on the subjective evaluation. A linear regression model highlighted statistically significant differences in the plasma drug concentration, after considering toxicity and dose reduction and controlling for the Reward Dependence Scale of the Temperament and Character Inventory between the EG and the CG. CONCLUSION: Adequate information and education on the therapy, using an RM strategy provided by a hospital pharmacist, seems to positively influence adherence to the treatment.

The role of alexithymia and empathy on radiation therapists' professional quality of life.

BACKGROUND AND PURPOSE: Physical and mental well-being are crucial for oncology professionals as they affect performance at work. Personality traits, as alexithymia and empathy, may influence professional quality of life. Alexithymia involves diminished skills in emotion processing and awareness. Empathy is pertinent to the ability to understand another's 'state of mind/emotion'. The PROject on Burn-Out in RadiatioN Oncology (PRO BONO) investigates professional quality of life amongst radiation oncology professionals, exploring the role of alexithymia and empathy. The present study reports on data pertinent to radiation therapists (RTTs). MATERIAL AND METHODS: An online survey targeted ESTRO members. Participants were asked to fill out 3 questionnaires for alexithymia, empathy and professional quality of life: (a) Toronto Alexithymia Scale (TAS-20); (b) Interpersonal Reactivity Index (IRI); (c) Professional Quality of Life Scale (ProQoL). The present analysis focuses on RTTS to evaluate compassion satisfaction (CS), secondary traumatic stress (STS) and Burnout and their correlation with alexithymia and empathy, using generalized linear modeling. Covariates found significant at univariate linear regression analysis were included in the multivariate linear regression model. RESULTS: A total of 399 RTTs completed all questionnaires. The final model for the burnout scale of ProQoL found, as significal predictors, the TAS-20 total score (ß = 0.46, p < 0 0.001), and the individual's perception of being valued by supervisor (ß = -0.29, p < 0.001). With respect to CS, the final model included TAS-20 total score (ß = -0.33, p < 0.001), the Empatic Concern domain (ß = 0.23, p < 0.001) of the IRI questionnaire and the individual's perception of being valued by colleagues (ß = 0.22, p < 0.001). CONCLUSIONS: Alexithymia increased the likelyhood to experience burnout and negatively affected the professional quality of life amongst RTTs working in oncology. Empathy resulted in higher professional fulfillment together with collegaues' appreciation. These results may be used to benchmark preventing strategies and implement organization-direct and/or individual-directed interventions.

Professional quality of life and burnout amongst radiation oncologists: The impact of alexithymia and empathy.

BACKGROUND AND PURPOSE: Different factors may influence the professional quality of life of oncology professionals. Among them, personality traits, as alexithymia and empathy, are underinvestigated. Alexithymia is about deficits in emotion processing and awareness. Empathy is the ability to understand another's 'state of mind'/emotion. The PROject on BurnOut in RadiatioN Oncology (PRO BONO) assesses professional quality of life, including burnout, in the field of radiation oncology and investigates alexithymia and empathy as contributing factors. MATERIAL AND METHODS: An online survey was conducted amongst ESTRO members. Participants completed 3 validated questionnaires for alexithymia, empathy and professional quality of life: (a) Toronto Alexithymia Scale; (b) Interpersonal Reactivity Index; (c) Professional Quality of Life Scale. The present analysis, focusing on radiation/clinical oncologists, evaluates Compassion Satisfaction (CS), Secondary Traumatic Stress (STS) and Burnout and correlates them with alexithymia and empathy (empathic concern, perspective taking and personal distress) with generalized linear modeling. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model. RESULTS: A total of 825 radiation oncologists completed all questionnaires. A higher level of alexithymia was associated to decreased CS (ß: -0.101; SE: 0.018; p < 0.001), increased STS (ß: 0.228; SE: 0.018; p < 0.001) and burnout (ß: 0.177; SE: 0.016; p < 0.001). A higher empathic concern was significantly associated to increased CS (ß: 0.1.287; SE: 0.305; p = 0.001), STS (ß: 0.114; SE: 0.296; p < 0.001), with no effect on burnout. Personal distress was associated to decreased CS (ß: -1.423; SE: 0.275; p < 0.001), increased STS (ß: 1.871; SE: 0.283; p < 0.001) and burnout (ß: 1.504; SE: 0.245; p < 0.001). CONCLUSIONS: Alexithymic personality trait increased burnout risk, with less professional satisfaction. Empathic concern was associated to increased stress, without leading to burnout, resulting in higher professional fulfillment. These results may be used to benchmark preventing strategies, such as work-hour restrictions, peer support, debriefing sessions, and leadership initiatives for professionals at risk.

Attachment style and parental bonding: Relationships with fibromyalgia and alexithymia.

OBJECTIVES: Fibromyalgia (FM) is a chronic pain syndrome, and alexithymia, which is a condition that is characterised by deficits in emotional self-awareness, is highly prevalent among individuals with FM. Insecure attachment styles and inadequate parental care appear to play an important role in the onset and maintenance of both alexithymia and chronic pain. Therefore, the present study aimed to examine the associations between attachment styles, parental bonding, and alexithymia among patients with FM and healthy controls (HC). METHODS: All participants completed a battery of tests that assessed alexithymia, attachment styles, and parental bonding. Two logistic regression models were tested to examine whether these variables predict (a) group membership (i.e. patients with FM vs. HC) and (b) the likelihood of having alexithymia (i.e. among patients with FM and HC). RESULTS: Alexithymia (i.e. difficulty identifying and describing feelings subscales of the 20-item Toronto Alexithymia Scale) significantly predicted group membership (i.e. the likelihood of having FM). On the other hand, educational level and dismissive attachment (i.e. the discomfort with closeness and relationships as secondary subscales of the Attachment Style Questionnaire) were the only significant predictors of the likelihood of having alexithymia. CONCLUSIONS: These findings highlight both the relevance of alexithymic traits to the definition of FM and centrality of an insecure attachment style to the manifestation of alexithymia.

Professional quality of life and burnout among medical physicists working in radiation oncology: The role of alexithymia and empathy.

BACKGROUND AND PURPOSE: The professional quality of life of radiation oncology professionals can be influenced by different contributing factors, including personality traits. Alexithymia involves deficits in emotion processing and awareness. Empathy is the ability to understand another's 'state of mind/emotion'. We investigated professional quality of life, including burnout, in radiation oncology, exploring the role of alexithymia and empathy and targeting the population of medical physicists (MPs), since this professional category is usually underrepresented in surveys exploring professional well-being in radiation oncology and MPs may experience professional distress given the increasing complexity of multimodal cancer care. MATERIAL AND METHODS: An online survey was addressed to ESTRO members. Participants filled out three questionnaires to evaluate alexithymia, empathy and professional quality of life: a) Toronto Alexithymia Scale (TAS-20); b) Interpersonal Reactivity Index (IRI); c) Professional Quality of Life Scale (ProQoL). Professional quality of life as per ProQoL was considered as dependent variable. The three domains of the ProQoL, namely compassion satisfaction (CS), secondary traumatic stress (STS) and burnout were correlated with alexithymia (as per TAS-20) and empathy (as per IRI with three subcategories: empathic concern, perspective taking and personal distress) and demographic/professional characteristics as independent variables. Generalized linear modeling was used. Significant covariates on univariate linear regression analysis were included in the multivariate linear regression model. RESULTS: A total of 308 medical physicists completed all questionnaires. Alexithymia as per TAS-20 was correlated to decreased CS (ß = -0.25, p < 0 0.001), increased likelihood for STS (ß = 0.26, p < 0 0.001) and burnout (ß = 0.47, p < 0 0.001). With respect to empathy, the 'Empatic Concern' subscale of the IRI was found to be a significant predictor for increased CS (ß = 0.19, p = 0 0.001) and increased STS (ß = 0.19, p < 0 0.001), without significant correlation with burnout. The individual's perception of being valued by own's supervisor was correlated to increased CS (ß = 0.23, p < 0.001), and decreased burnout (ß = -0.29, p < 0.001). CONCLUSIONS: Alexithymic personality trait increased the likelihood to develop burnout, with less professional satisfaction amongst MPs working in radiation oncology. Empathy results in higher professional fulfilment. These results may be used to benchmark preventing strategies, including peer support, debriefing sessions, leadership initiatives and work-load limitation strategies.

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis.

Individual differences in emotional functioning, pain appraisal processing, and perceived social support may play a relevant role in the subjective experience of pain. Due to the paucity of data regarding individuals with Rheumatoid Arthritis (RA), the present study aimed to examine pain intensity, emotional functioning (psychological distress and alexithymia), pain appraisal (pain beliefs, pain catastrophizing, and pain-related coping strategies) and social support, and their relationships with the health-related quality of life (HRQoL) in patients with RA. Data were collected from 108 female patients diagnosed with RA. Clinically relevant levels of depressive and anxiety symptoms assessed by the HADS subscales were present in 34% and 41% of the patients, respectively, and about 24% of them exhibited the presence of alexithymia. The results of hierarchical multiple regression analyses showed that pain intensity, alexithymia, the maladaptive beliefs regarding the stability of pain and the coping strategy of guarding explained 54% of the variance in the physical component of HRQoL (p < 0.001). Depression subscale of the HADS, alexithymia, the coping strategy of resting, and the rumination factor of pain catastrophizing significantly explained 40% of the variance in the mental component of HRQoL (p < 0.001). The present findings provide evidence regarding the importance of emotional functioning and pain appraisal in the negative impact of RA on patients' quality of life. These findings provide additional evidence for the biopsychosocial model of chronic pain, further supporting the complex interaction between emotional, cognitive, and behavioral processes in patients with chronic pain.

Posttraumatic growth in breast cancer survivors: Are depressive symptoms really negative predictors?

OBJECTIVE: Breast cancer (BC) diagnosis is a potentially traumatic event, the related challenges of which can trigger positive or negative reactions. Posttraumatic growth (PTG) is defined as a positive psychological change experienced as a result of the struggle. The present study aimed to shed light on the relationship between the evolution of depressive symptoms over time and PTG in a group of BC survivors. METHOD: Depressive symptoms at the time of diagnosis (T0) and 2 years later (T1) were evaluated to investigate their potential impact on the level of PTG at T1. A total of 147 BC patients were recruited and divided into 4 groups according to the changes in depressive symptoms they experienced over time (patients who were never depressed, no longer depressed, still depressed, and depressed now). A One-way analysis of variance was run to compare the levels of PTG for the four groups. RESULTS: The One-way analysis of variance showed that PTG score was significantly different among groups with different levels of depressive symptoms (p = .008). Post hoc comparisons indicated that the PTG score was statistically significantly higher in the no longer depressed group compared with the still depressed and depressed now groups. CONCLUSIONS: The current results suggest that high levels of depressive symptoms, displayed at the time of cancer diagnosis, can be considered catalysts for PTG at follow-up, on condition that women experience elevated depressive symptoms only in the first period of the disease. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Exploring demoralization in end-of-life cancer patients: Prevalence, latent dimensions, and associations with other psychosocial variables.

OBJECTIVE: Demoralization is an existential distress syndrome that consists of an incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, and impaired self-esteem. It can affect cancer patients, and the Demoralization Scale is a valid instrument to assess it. The present study aimed to investigate the prevalence of demoralization in end-of-life cancer patients and its associations with the medical and psychosocial variables. In addition, the latent dimensions of demoralization emerging in this distinctive population were explored. METHOD: The study is cross-sectional. The sample consisted of 235 end-of-life cancer patients with a Karnofsky performance status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and medical data was gathered by a palliative physician and a set of validated rating scales, assessing demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity, was administered by a psychologist during the first consultation. RESULT: Sixty-four participants (27.2%) had low demoralization, 50.2% (n = 118) had medium demoralization, and 22.6% (n = 53) had high demoralization. Factor analysis evidenced a five-factor solution that identified the following demoralization factors: Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure, and Dysphoria. All the considered variables were associated with demoralization, except for pain, nausea, breathing problems, and sociodemographic and clinical variables. SIGNIFICANCE OF RESULTS: End-of-life cancer patients showed higher levels of demoralization than has been reported in other studies with advanced cancer. These data could suggest that demoralization could increase in proximity to death and with impaired clinical condition. In particular, the five demoralization dimensions that emerged could represent the typical concerns around which the syndrome evolves in end-of-life cancer patients. Finally, spiritual well-being could play a protective role with respect to demoralization.

The Traumatic Experience of Breast Cancer: Which Factors Can Relate to the Post-traumatic Outcomes?

Background: Post-traumatic growth (PTG) is considered a positive outcome of struggling with a traumatic event, distinct, and opposite from negative outcomes, i.e., psychological distress. The present study aimed to shed light on the relationship between potentially relating factors (i.e., coping strategies, perceived social support, and attachment style) and both positive and negative psychological outcomes. Methods: A total of 123 breast cancer survivors were recruited, who completed a battery of self-report questionnaires, assessing PTG, psychological distress, coping strategies, perceived social support, and attachment style. Three regression analyses were run to evaluate whether relating factors were significant predictors of the positive and negative psychological outcomes. Results: The regression analyses showed that the "Fatalism" coping strategy and perceived social support were two significant predictors of PTG. Instead, the "Helpless-Hopeless" and "Anxious Preoccupation" coping strategies, as well as an insecure attachment style, were significant predictors of depression, while the "Anxious Preoccupation" coping strategy and an insecure attachment style were significant predictors of anxiety. Conclusions: The present findings showed that the factors underlying a positive or negative outcome are different and specific. While perceived social support and a fatalistic attitude seem to play a key role in the positive outcome, dysfunctional coping strategies, together with an insecure attachment style, appear to be related with negative psychological outcome. Considering these factors in clinical practice would help patients to give meaning to their traumatic experience, enhancing psychological growth.

Deep brain stimulation of the subthalamic nucleus in Parkinson's disease: Relationship between the electrode trajectory and cognitive decline.

INTRODUCTION: It remains to be clarified whether penetration of the caudate nucleus increases the risk of cognitive decline in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS: A retrospective analysis of pre/postoperative neuropsychological changes was performed with 46 consecutive patients with PD who underwent DBS of the STN. In particular, to evaluate the possible relationship between cognitive changes and DBS lead trajectories, repeated-measures ANCOVAs were conducted to analyze the effects of group (23 patients with vs 23 patients without penetration of the caudate nucleus) and time (T0 vs T1) for each neuropsychological test. RESULTS: A statistically significant main effect of time was observed in the Trail Making Test - Part B (TMT-B), as well as in both the phonemic and semantic (F [1, 44] = 35.59, p < 0.001, PrtEta2 = 0.447) verbal fluency tasks, and the results suggested postoperative cognitive decline. However, no significant interaction effects of time and group were observed. The results indicated that the extent of the decline was comparable between the caudate and non-caudate penetration groups, and no relationship was found between cognitive changes and caudate penetration. CONCLUSION: Although postoperative cognitive decline was observed in some attentional-executive functions, which were assessed by the verbal fluency and TMT-B tasks, the trajectory passing through the caudate appeared not to increase the risk of cognitive decline in patients with PD undergoing DBS of the STN.