a1 Department of Neurology, University of Cologne, Cologne, Germany
a2 Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, University of Cologne, Cologne, Germany
a3 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
a4 Department of Stereotaxy and Functional Neurosurgery, University of Cologne, Cologne, Germany
a5 Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Grenoble, France
a6 Department of Psychiatry, University of Toronto, University Health Network, Toronto, Canada
a7 Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
Background Clinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients.
Method In this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients’ personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed.
Results Personality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group.
Conclusions Our results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.
(Received August 16 2013)
(Revised April 09 2014)
(Accepted April 10 2014)
(Online publication May 12 2014)
c1 Address for correspondence: C. J. Lewis, Department of Neurology, University Hospital Cologne, Kerpener Str. 62, D-50937 Cologne, Germany. (Email: firstname.lastname@example.org) [C.J.L.] (Email: email@example.com) [L.T.]
† These authors contributed equally to this work.