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Abstract BACKGROUND Dysphagia in Parkinson’s disease (PD) increases aspiration pneumonia risk and is associated with poor prognosis. Although subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms, dysphagia often persists or progresses postoperatively. The role of preoperative cognitive function in long-term swallowing outcomes remains unclear. We investigated whether preoperative cognitive function, particularly frontal-executive function, is associated with swallowing outcomes 5 years after STN-DBS. Methods We retrospectively analyzed 68 patients with PD who underwent STN-DBS and completed 5-year follow-up. Frontal-executive function was assessed using the Frontal Assessment Battery (FAB) and global cognition using the Mini-Mental State Examination (MMSE). Swallowing deterioration was defined as a ≥ 1-point increase over 5 years on the swallowing-related item of the UPDRS or MDS-UPDRS Part II. FAB (primary exposure) and MMSE (pre-specified secondary exposure) were modeled as dichotomized variables (FAB Results At 5 years, 34 patients (50.0%) showed swallowing deterioration. In primary dichotomized analyses, low-FAB patients had higher adjusted odds than high-FAB patients (OR 2.90, 95% CI 0.74–12.96), whereas MMSE-defined cognitive impairment yielded an estimate close to the null (OR 1.12, 95% CI 0.13–11.9). Continuous sensitivity analyses yielded similar adjusted odds per one-point decrease for FAB (OR 1.16, 95% CI 0.94–1.47) and MMSE (OR 1.14, 95% CI 0.89–1.49). The two scales differed structurally in preoperative variance: MMSE was compressed against its ceiling (median 29, upper quartile 30 = maximum), whereas FAB retained discriminative range (median 15, upper quartile 16, maximum 18). Conclusions Point estimates indicated elevated odds of long-term post-DBS swallowing deterioration with both lower FAB and lower MMSE, although the confidence intervals crossed 1.0. MMSE was compressed against its ceiling, whereas FAB retained discriminative range, enabling finer-grained patient differentiation. Confirmation in larger multicenter cohorts is warranted.
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