Perceived social support declines after deep brain stimulation surgery in patients with Parkinson's disease.

INTRODUCTION: The Social Provisions Scale (SPS) measures a person's perceived social support. We evaluated the perceived social support in Parkinson's disease (PD) patients before and after subthalamic nucleus (STN) deep brain stimulation (DBS) and its impact on clinical outcomes following DBS. METHODS: We analyzed 55 PD patients who underwent STN DBS surgery and completed the SPS, PDQ-39, and MDS-UPDRS Parts I-IV before and 6-12 months after surgery. Some patients also completed global cognitive, mood and apathy scales. Caregivers completed the CBI at each visit. Linear regression models and linear mixed models evaluated the association between the SPS baseline score, MDS-UPDRS and PDQ-39 scores, the association between MDS-UPDRS, CBI and the SPS follow-up score, and the association between SPS, global cognition and other psychological variables. RESULTS: DBS implantation improved MDS-UPDRS I-IV and PDQ-39 scores. Perceived social support declined after DBS (baseline SPS total 82.55 ± 7.52 vs. follow-up SPS total 78.83 ± 9.02, p = 0.0001). Baseline SPS total score was not significantly associated with the MDS-UPDRS or PDQ-39 scores at follow-up. MDS-UPDRS scores and the CBI at follow-up had no significant association with SPS total score at follow-up. Measures of global cognition, mood and apathy were associated with the SPS before and after DBS, and the association was independent of STN DBS. CONCLUSION: After STN DBS, PD patients experienced a decrease in perceived social support, but baseline perceived social support did not impact clinical outcomes. It is important to further identify factors that may contribute to this perception of worsened social support.

The impact of dispositional optimism and depression on post-operative motor functioning following deep brain stimulation surgery for Parkinson's disease.

INTRODUCTION: The primary goal of subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD) is to improve motor function. Dispositional optimism has been associated with better physical outcomes following a rehabilitation program in PD but has not been investigated in relation to STN-DBS. This study investigated the influence of dispositional optimism on motor outcomes following STN-DBS in individuals with PD. METHODS: A retrospective data analysis of 33 individuals with PD who underwent STN-DBS was conducted. Linear regression was used to determine whether dispositional optimism, measured by the Life Orientation Test-Revised questionnaire, predicted change in motor symptoms following DBS surgery, as assessed by the Movement Disorder Society-sponsored revision of the Unified PD Rating Scale, Part III. Self-reported levels of depressive and anxiety symptoms were included as co-variates. RESULTS: Higher pre-operative dispositional optimism combined with less self-reported depressive symptoms predicted greater post-operative improvement in motor symptoms from the baseline OFF-medication to post-operative ON-medication/ON-stimulation state, accounting for 38.8% of the variance in post-operative change. CONCLUSION: The large percentage of variance in post-STN-DBS motor change predicted by pre-operative dispositional optimism and depressive symptoms suggests that assessment of these variables prior to surgery may provide valuable information for clinicians regarding the surgery's ultimate initial motor benefit for individuals with PD. If modifiable, these variables may provide cost-effective targets to improve motor outcomes of STN-DBS in PD.