Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease
Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease
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DOI：
10.1016/j.jns.2011.06.028
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发表时间：
2011-11-15
影响因子：
4.4
通讯作者：
Deuschl, Guenther
中科院分区：
文献类型：
--
作者：
Witt, Karsten;Daniels, Christine;Deuschl, Guenther
丘脑底核深部脑刺激(DBS)显著改善帕金森病(PD)患者的生活质量(QOL)。痴呆被认为是STN-DBS的禁忌症。然而，没有一项对照研究评估了STN-DBS对伴有临界整体认知损害的PD患者的生活质量和运动结局的影响。我们研究了一组STN-DBS患者的临床基线和进展参数，这些患者的总体认知评分仍在非痴呆范围，但评分在Mattis痴呆评定量表(MDRS)的最低四分位数，MDRS是衡量全球认知功能的指标。分析了德国一项随机对照研究的数据，该研究比较了DBS(60名患者)和最佳医疗(BMT，59名患者)。使用帕金森氏病问卷(PDQ-39)评估基线和6个月随访期间患者生活质量评分的变化。根据患者在基线时的MDRS表现被分为四组，并在运动结果和生活质量的背景下对这些组进行比较。STN-DBS组60名患者中有12名在MDRS的最低四分位数(范围在130到137分之间)得分。个人分析显示，12名患者中有3名显示出临床相关的生活质量改善，而组统计数据显示，与骨髓移植组相比，STN-DBS治疗后的生活质量没有任何显着改善。由于生活质量没有改善的原因不能解释为STN-DBS术后在运动功能、刺激环境和精神量表方面的未能改善，总体认知得分接近临界值的患者的生活质量没有改善可能特别与认知功能低下有关。(C)2011爱思唯尔B.V.保留所有权利。
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in Parkinson's disease (PD). Dementia is considered as a contraindication for STN-DBS. However, no controlled study assessed the impact of STN-DBS on the QoL and motor outcome in PD patients with a borderline global cognitive impairment. We studied clinical baseline and progression parameters in a cohort of STN-DBS patients with a global cognitive score still in the non-demented range but scoring in the lowest quartile of the Mattis Dementia Rating Scale (MDRS), a measure of global cognitive functioning. Data from a German randomised controlled study comparing DBS (60 patients) with best medical treatment (BMT, 59 patients) were analysed. Changes in patients' QoL scores were assessed using the Parkinson's disease questionnaire (PDQ-39) at baseline and at the 6 months follow up. Patients were split into four groups according to their MDRS performance at baseline and these groups were compared in the context of motor outcome and QoL Twelve out of sixty patients of the STN-DBS group scored in the lowest quartile of the MDRS (range between one hundred thirty and one hundred thirty seven points). An individual analysis revealed that 3 of 12 patients showed a clinical relevant improvement in QoL whereas the group statistics did not reveal any significant improvement in QoL measures after STN-DBS compared to the BMT group. Since this failure to improve in QoL cannot be explained by a failure to improve in motor functions, stimulation settings and psychiatric scales after STN-DBS, the failure to improve in QoL in patients with a borderline global cognitive score might be specifically related to lower cognitive functioning. (C) 2011 Elsevier B.V. All rights reserved.