AGR – 1 Barriers to Deep Brain Stimulation (DBS) in Latinx Patients with Parkinson’s Disease: a Case Series

Abstract Objective Latinx individuals with Parkinson’s disease (PD) frequently present with reduced health literacy, as well as cultural, socioeconomic, and linguistic barriers which can adversely limit their access to treatments, including deep brain stimulation (DBS). This case series describes two Latinx patients receiving pre-surgical neuropsychological evaluations with an emphasis of diagnostic and prognostic limitations. Method Two bilingual Latinx/a/e patients (ages 53 and 68) underwent neuropsychological evaluation as part of a presurgical assessment. Medical history for both was significant for PD with visual/auditory hallucinations, mood and cognitive impairments. Patient 1 also had a history of developmental delay, while Patient 2 had a co-occurring Chiari malformation. Both patients received comprehensive assessments of cognition and mood by Spanish-speaking evaluators using culture-minded batteries. Results Patient 1 demonstrated impairments in attention, memory, processing speed, and executive functioning, with variable language and visuospatial abilities. Rapid forgetting suggested possible neurodegeneration, though significant decline from baseline was unclear. She endorsed severe depression and anxiety symptoms. Patient 2 exhibited similarly extensive deficits but declined to report on emotional functioning due to concerns of family stigma. Both patients’ histories indicated low health literacy, limited English proficiency, and preoperative anxiety on their functional presentation and performance on testing. Conclusion Though patients were sub-optimal DBS candidates due to significant neurocognitive impairments and psychiatric symptoms, it was difficult, if not impossible, to conclusively, reliably, and validly extricate “true” deficits implicating exclusionary conditions (i.e., likely Lewy Body or Alzheimer’s disease) from impairments stemming from sociocultural disadvantages, psychometric confounds and other barriers to optimized care.