The role of neuropsychologist in qualifying patients with movement disorders for deep brain stimulation

The appropriate selection of candidates with movement disorders for deep brain stimulation requires the engagement of a multidisciplinary team, including a movement disorders specialist, neurosurgeon, psychiatrist, neuroradiologist, neurological nurse and a neuropsychologist. The neuropsychological assessment should address not only the cognitive function but also include an interview on the emotional functioning, coping mechanisms, social support, and the adequacy of expectations with regards to deep brain stimulation. Neuropsychiatric interview with the patient and - if possible - his/her proxy, should be supported, but not replaced, by questionnaire assessment. Also, if surgery under local anesthesia is considered, the neuropsychological evaluation can help to establish if the patient is cognitively and emotionally capable of enduring it. In this paper, all the important aspects of neuropsychological evaluation are presented, with special emphasis on dealing with motor limitations during cognitive assessment, conducting the behavioral assessment and addressing the patient's expectations concerning deep brain stimulation efficacy. Neuropsychiatric evaluation should cover not only the presence and severity of affective symptoms, but also the relationship between motor and emotional state, suicidal ideations, psychosocial stability, and a variety of behavioral problems, including pseudobulbar affect, irritability, and psychotic symptoms. Overall, the comprehensive neuropsychological evaluation for deep brain stimulation candidates extends far beyond cognitive assessment.