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However, gait disorders and non-motor symptoms (NMS) may persist or emerge following surgery, diminishing quality of life and complicating clinical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To characterize the dominant axes of clinical covariance across motor and non-motor domains before and after STN\u2013DBS, and to determine whether non-motor symptom severity moderates post-DBS gait and mobility change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      100 PD patients undergoing STN\u2013DBS (mean age 60.2 \u00b1 7.6\u00a0years; 67% male) were studied. Principal component analysis (PCA) was performed on thirteen motor and non-motor sub-scores at pre-DBS, 1-year follow-up (1-y FU), and a subset (\n                      <jats:italic>n<\/jats:italic>\n                      = 33) at 3\u20135-year follow-up. Moderation was tested using analysis of covariance (ANCOVA): each 1-year motor outcome was regressed on its pre-DBS baseline, a non-motor moderator, and their interaction, adjusting for age and disease duration, with a significant interaction indicating that baseline non-motor severity was associated with the degree of subsequent motor recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      PCA identified a core motor triad: gait, mobility, and freezing of gait as the primary source of clinical variance at all timepoints (PC1: 35% pre-DBS, declining to 28% at 3\u20135-y FU), PC1 was the only component to exceed a permutation null (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001), with memory-related impairment increased at longer-term follow-up. Moderation analysis showed that higher pre-operative mood burden specifically for psychomotor and psychosomatic\u00a0symptoms were associated with poorer recovery of mobility (Psychomotor\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 1.16,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05). At 1-y FU anxiety and psychosomatic symptoms showed concurrent associations with mobility and overall motor burden (Anxiety\n                      <jats:italic>\u03b2<\/jats:italic>\n                      = 2.30,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>STN\u2013DBS outcomes extend beyond global motor improvement and may be shaped by associations spanning the motor, cognitive, and mood domains. Higher NMS baseline burden was associated with poorer mobility recovery, and mood symptoms at follow-up were associated with concurrent motor burden. These exploratory findings support considering multi-domain pre-operative assessment and post-operative mood monitoring, as potential targets for optimizing motor outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14160-x","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:49:51Z","timestamp":1790884191000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-motor symptoms burden and motor recovery following STN\u2013DBS in Parkinson's disease: a data-driven longitudinal analysis"],"prefix":"10.1007","volume":"273","author":[{"given":"Ghadir","family":"Abbas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Peach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uchralt","family":"Temuulen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunyou","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanmoy","family":"Sil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kufner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Endres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Volkmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Lange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Reich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"14160_CR1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/ene.14108","volume":"27","author":"R Balestrino","year":"2020","unstructured":"Balestrino R, Schapira A (2020) Parkinson disease. 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F.L. reports honoraria from Boston Scientific. J.V. reports honoraria from Boston Scientific, Medtronic, Newronika, UCB, Zambon, and Abbott, and has received research grants from the German Research Foundation and the German Ministry of Research and Education. M.M.R. is supported by the German Research Foundation (DFG) and the German Federal Ministry of Education and Research (BMBF), and reports grant support and honoraria for speaking from Medtronic and Boston Scientific. M.E. has received grants from Bayer (unrestricted grant to Charit\u00e9 for the MonDAFIS study and Berlin AFib Registry, paid to institution), consulting fees paid to institution from Bayer, and honoraria for lectures and educational events paid to institution from Bayer, Pfizer, Amgen, GSK, and Novartis; he has participated on data safety monitoring boards for BMS, Bayer, and Daiichi Sankyo (no personal fees); and holds unpaid leadership roles in the European Academy of Neurology, the German Center for Neurodegenerative Diseases, and the International Society for Cerebral Blood Flow and Metabolism, all outside the submitted work.","order":1,"name":"Ethics","label":"Conflicts of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University of W\u00fcrzburg (No. 248\/20-me).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. The manuscript does not contain any individual person's identifying data or images.","order":4,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"636"}}