Neuropsychologic assessment of patients for movement disorder surgery

The neuropsychologic evaluation of patients under consideration fur movemen t disorder surgery is recognized as being an essential component of the pre operative process. Patients with early-stage concomitant dementia must be i dentified and the relative risk of postoperative cognitive decline evaluate d. Knowledge of the patterns of an individual's strengths and weaknesses mi ght also be a factor in deciding on a neurosurgical procedure. Although the advent of pallidal deep brain stimulation (DBS) has possibly resulted in r educed risk of induced cognitive impairment, even this procedure has been a ssociated with negative sequelae. DBS within the subthalamic nucleus is bec oming the method of choice and this may lead to cognitive and behavioral co mpromise, especially in the elderly patient. The team considering the estab lishment of neurosurgical treatment is often at a loss to decide how much n europsychologic testing is required to determine relative risks of cognitiv e or behavioral morbidity as a consequence of the procedure. A brief summar y of expected outcome and of pertinent family process and psychodynamic iss ues are addressed. This article is intended to serve as a guide to permit c linicians to choose the appropriate length and depth of neuropsychologic as sessment, but also to highlight the confounding factors often present in th ese patients.