Bilateral subthalamic stimulation impairs cognitivemotor performance in Parkinsons disease patients
Bilateral subthalamic stimulation impairs cognitivemotor performance in Parkinsons disease patients
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DOI：
10.1093/brain/awn238
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发表时间：
2008-12-01
期刊：
影响因子：
14.5
通讯作者：
Vitek, Jerrold L.
中科院分区：
文献类型：
--
作者：
Alberts, Jay L.;Voelcker-Rehage, Claudia;Vitek, Jerrold L.
深部脑刺激 (DBS) 是一种外科手术，已被证明可有效改善晚期帕金森病的主要运动体征，但认知功能下降与双侧丘脑底核 (STN) DBS 相关。尽管事实上大多数日常生活活动显然都同时进行运动和认知功能，但术后认知和运动功能的评估通常是相互独立的。本研究的主要目的是确定单侧和双侧 STN DBS 对晚期帕金森病患者在单任务和双任务条件下上肢运动功能和认知能力的影响。数据收集自 8 名年龄在 48 岁至 70 岁（平均 56.5 岁）之间双侧放置 STN 刺激器的晚期帕金森病患者。 DBS 设备的刺激参数经过临床优化，并且在参与研究之前至少 6 个月保持稳定。当患者在三种刺激条件下停止服用抗帕金森病药物时收集数据：停止刺激、单侧 DBS 和双侧 DBS。在每种刺激条件下，患者在单任务和双任务条件下执行认知（n-back 任务）和运动（力跟踪）任务。在双任务条件下，患者同时执行 n-back 和力维持任务。在相对简单的双任务条件下，单侧和双侧刺激下的认知或运动表现没有差异。随着双任务复杂性的增加，与单侧刺激相比，双侧刺激的认知和运动表现明显较差。在最复杂的双任务条件下（即 2 后力跟踪），双边刺激产生的运动表现水平与关闭刺激条件相似。在适度的双任务条件下，双侧 STN DBS 的认知和运动功能显着下降，表明单侧手术可能是某些患者（特别是症状不对称的患者）双侧 DBS 的替代方案。从临床角度来看，这些结果强调了在 DBS 编程期间同时评估认知和运动功能的必要性，因为这些条件可以更好地反映日常活动进行的环境。
Deep brain stimulation (DBS) is a surgical procedure that has been shown effective in improving the cardinal motor signs of advanced Parkinsons disease, however, declines in cognitive function have been associated with bilateral subthalamic nucleus (STN) DBS. Despite the fact that most activities of daily living clearly have motor and cognitive components performed simultaneously, postoperative assessments of cognitive and motor function occur, in general, in isolation of one another. The primary aim of this study was to determine the effects of unilateral and bilateral STN DBS on upper extremity motor function and cognitive performance under single- and dual-task conditions in advanced Parkinsons disease patients. Data were collected from eight advanced Parkinsons disease patients between the ages of 48 and 70 years (mean 56.5) who had bilaterally placed STN stimulators. Stimulation parameters for DBS devices were optimized clinically and were stable for at least 6 months prior to study participation. Data were collected while patients were Off anti-parkinsonian medications under three stimulation conditions: Off stimulation, unilateral DBS and bilateral DBS. In each stimulation condition patients performed a cognitive (n-back task) and motor (force tracking) task under single- and dual-task conditions. During dual-task conditions, patients performed the n-back and force-maintenance task simultaneously. Under relatively simple dual-task conditions there were no differences in cognitive or motor performance under unilateral and bilateral stimulation. As dual-task complexity increased, cognitive and motor performance was significantly worse with bilateral compared with unilateral stimulation. In the most complex dual-task condition (i.e. 2-back force tracking), bilateral stimulation resulted in a level of motor performance that was similar to the Off stimulation condition. Significant declines in cognitive and motor function under modest dual-task conditions with bilateral but not with unilateral STN DBS suggest that unilateral procedures may be an alternative to bilateral DBS for some patients, in particular, those with asymmetric symptomology. From a clinical perspective, these results underscore the need to assess cognitive and motor function simultaneously during DBS programming as these conditions may better reflect the context in which daily activities are performed.