October 18, 2026

@michaelokun

Folks w/ GBA1 Parkinson's should NOT automatically be excluded from DBS! GBA1 is a gene associated w/ an increased risk of Parkinson's disease and a greater likelihood of cognitive decline. Deep brain stimulation is a surgical treatment that uses electrical stimulation to improve movement symptoms. Evridiki Asimakidou and colleagues describe in a new paper in Movement Disorders how the timing of DBS may influence cognitive trajectories in folks w/ GBA1-associated Parkinson's disease. Key points: - This multicenter study included 343 folks w/ Parkinson's disease who underwent subthalamic nucleus (STN) DBS, including 91 GBA1 carriers and 252 non-carriers. - Folks w/ GBA1 Parkinson's who underwent DBS later in their disease course experienced significantly faster cognitive decline than those receiving DBS earlier. The strongest differences emerged around the 7- to 8-year disease duration thresholds. - Cognitive decline was greater overall in GBA1 carriers compared to nocarriers, however the severity of the GBA1 genetic variant did not clearly predict the cognitive trajectory. My take: This study addresses an important clinical dilemma. Should we deny a potentially life-changing therapy to someone simply because they carry a GBA1 variant and may be at greater risk for cognitive decline? I would argue absolutely not. We must have thoughtful and transparent discussions about cognitive trajectories, including the possibility of worsening memory and thinking over time. However, an increased risk of cognitive decline does not automatically mean someone should be excluded from DBS. We should be discussing motor benefits, current cognitive function, quality of life, disease duration, individual goals and the potential window of opportunity for treatment. Importantly, this observational study does not prove that earlier DBS prevents cognitive decline or that DBS itself causes the decline.