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. 2022 Jan 17;145(4):1410–1421. doi: 10.1093/brain/awac012

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© The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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Using the cognitive decline heat map for risk assessment and potential reprogramming. Patients were stratified into three risk groups based on VTA overlap with our cognitive decline heat map (A). Parkinson’s disease patients in the high-risk cohort showed significantly more cognitive decline than patients in low-risk cohort and medium risk cohort. We simulated all possible monopolar electrode choices for patients in the high-risk group (B) and choose the setting that would minimize the risk of cognitive decline (C). In 8 of 11 patients there were alternative programming settings where cognitive decline could potentially be reduced. One of these high-risk patients presented for routine clinical follow-up and was reprogrammed, moving from a high risk setting to a medium-risk setting based on the heat map (D). The MDRS improved by 7 points, while parkinsonism was unchanged (48% to 52% UPDRS III reduced to baseline).