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To the Editor: In their randomized controlled trial, Dr Weaver and colleagues¹ reported a significant improvement in the motor function of participants with advanced Parkinson disease (PD) treated with bilateral deep brain stimulation, compared with best medical therapy. Dementia is often cited as a contraindication to deep brain stimulation on practical grounds. This is particularly (but not exclusively) true when it is felt that the patient will be unable to cooperate during surgery.² Indeed, participants with Mini-Mental State Examination (MMSE) scores of 24 or less were excluded from the trial. The prevalence of dementia in advanced PD may be greater than 70%.³ Therefore, treatment with deep brain stimulation may only be offered to a minority of patients with severe motor symptoms.

The sensitivity of MMSE in detecting dementia in PD has been questioned. Although a score of less than 25 is likely to indicate cognitive impairment, a higher score may . . . [Full Text of this Article]

Richard W. Genever, MBChB, MRCP
richard.genever@chesterfieldroyal.nhs.uk
Chesterfield Royal Hospital NHS Foundation Trust
Chesterfield, United Kingdom

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RELATED ARTICLE

Bilateral Deep Brain Stimulation vs Best Medical Therapy for Patients With Advanced Parkinson Disease: A Randomized Controlled Trial
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Deep Brain Stimulation for Patients With Advanced Parkinson Disease—Reply
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