The effects of bilateral Subthalamic Nucleus Deep Brain Stimulation (STN DBS) on cognition in Parkinson disease
The effects of bilateral Subthalamic Nucleus Deep Brain Stimulation (STN DBS) on cognition in Parkinson disease
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DOI：
10.1016/j.jns.2008.06.010
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发表时间：
2008-10-15
影响因子：
4.4
通讯作者：
Jeon, Beom S.
中科院分区：
文献类型：
--
作者：
Heo, Jae-Hyeok;Lee, Kyoung-Min;Jeon, Beom S.
刺激丘脑底核对认知和情绪的影响尚未得到很好的证实。作者评估了帕金森病（PD）患者术后6个月和1年时双侧丘脑底核脑深部电刺激（DBS）对认知和情绪的影响。从首尔国立大学医院的运动障碍中心招募了46名患者。神经心理学测试进行了三次，前，6个月后，手术后一年。患者平均年龄为58岁，平均受教育年限为8年。46名患者中有18名为男性。用于评估认知功能的工具有：简易精神状态检查（MMSE）、连线测验（TMT）、韩国波士顿测验（K-BNT）、Rey-Kim记忆成套测验、凹槽钉板测验、Stroop测验、流畅性测验、威斯康星州卡片分类测验（WCST）和贝克抑郁量表（BDI）。在这些测试中，非文字记忆测试、Stroop测试和流畅性测试显示出统计学上的显著变化。使用Rey-Kim记忆电池进行的言语记忆测试显示，术后6个月和1年时延迟回忆和识别能力下降，而非言语记忆没有显示出有意义的变化。在额叶功能测试方面，发现Stroup测试和流畅性测试结果在6个月时加重，并持续到术后1年。以前的研究一直报告说，言语流畅性下降，自我报告的抑郁症状改善后，bepaly在线网投DBS。然而，在本研究中，贝克抑郁量表（B.D.I.）并没有显著改变。其他测试，即MMSE、TMT、K-BNT、凹槽钉板测试和WCST也未显示出显著变化。在基线特征中，发现发病年龄、接受全日制教育的年数和左旋多巴等效剂量与术后神经心理学测试结果下降相关。运动改善与认知功能下降的相关性不显著，提示刺激作用仅限于大脑皮层与运动相关的部分。总之，帕金森病患者双侧DBS并没有导致认知功能的显著全面恶化。然而，我们的研究结果表明，它对记忆和额叶功能有轻微的长期有害影响。(c)2008 Elsevier B.V.保留所有权利。
The effects of subthalamic nucleus (STN) stimulation on cognition and mood have not been well established. The authors estimated cognitive and mood effects of bilateral subthalamic nucleus deep brain stimulation (STN DBS) in patients with Parkinson's disease (PD) at 6 months and 1 year postoperatively. Forty-six patients were recruited from the Movement Disorder Center at Seoul National University Hospital. Neuropsychologic tests were performed three times, before, 6 months after, and I year after surgery. Mean patient age was 58 and mean education duration 8 years. Eighteen of the 46 patients were men. The instruments used for assessing cognitive functions were: the Mini-Mental Status Examination (MMSE), the Trail Making Test (TMT), the Korean Boston Naming Test (K-BNT), the Rey-Kim Memory Battery, the Grooved pegboard test, the Stroop test, a fluency test, the Wisconsin Card Sorting test (WCST), and the Beck depression inventory (BDI). Of these tests, the verbal memory test, the Stroop test, and the fluency test showed statistically significant changes. The verbal memory test using the Rey-Kim memory battery showed a decline in delayed recall and recognition at 6 months and I year postoperatively, whereas nonverbal memory showed no meaningful change. In terms of frontal lobe function tests, Stroup test and fluency test findings were found to be aggravated at 6 months and this continued at 1 year postoperatively. Previous studies have consistently reported a reduction in verbal fluency and improvements in self-reported symptoms of depression after STN DBS. However, in the present study, Beck depression inventory (B.D.I.) was not significantly changed. Other tests, namely, MMSE, TMT, K-BNT, Grooved pegboard test, and the WCST also failed to show significant changes. Of the baseline characteristics, age at onset, number of years in full-time education, and L-dopa equivalent dosage were found to be correlated with a postoperative decline in neuropsychological test results. The correlation of motor improvement and cognitive deterioration was not significant, which suggests that the stimulation effect is rather confined to the motor-related part in the STN. in conclusion, bilateral STN DBS in Parkinson's disease did not lead to a significant global deterioration in cognitive function. However, our findings suggest that it has minor detrimental long-term impacts on memory and frontal lobe function. (c) 2008 Elsevier B.V. All rights reserved.