Impact of deep brain stimulation of the ventral anterior limb of the internal capsule on cognition in depression
Impact of deep brain stimulation of the ventral anterior limb of the internal capsule on cognition in depression
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DOI：
10.1017/s0033291717000113
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发表时间：
2017-07-01
影响因子：
6.9
通讯作者：
Denys, D.
中科院分区：
文献类型：
--
作者：
Bergfeld, I. O.;Mantione, M.;Denys, D.
背景资料。初步研究报告，脑深部刺激(DBS)对难治性抑郁症(TRD)患者的认知没有负面和可能的正面影响。然而，这些研究既没有对实践效果进行对照，也没有将积极刺激与虚假刺激进行比较。为了解决这些局限性，我们比较了25名接受内囊腹侧前肢DBS的TRD患者(Valic)和21名在性别、年龄和教育水平上匹配的健康对照组(HCS)。这两组人都进行了剑桥神经心理测试自动化电池的分测试，评估了语言和视觉空间记忆、注意力、认知灵活性、精神运动功能、规划和物体命名。TRD患者在DBS手术前3周(基线)、术后3周(T1)和DBS优化后52周(T2)进行测试。在基线、基线后6周(T1)和基线后20-24周(T2)测试HCS。随后，TRD患者进入随机双盲交叉阶段，在这一阶段中，他们在积极刺激阶段和假刺激阶段进行测试。TRD患者在从基线到T1的即刻言语再认测试中没有改善，而HCS患者有改善(x组时间：P=0.001)。TRD患者和HCS患者在测试延迟言语回忆、视觉空间记忆、计划和物体命名的测试中都有所改善(均为P<；0.01)。积极刺激和虚假刺激对任何一项测试都没有不同的影响。Valic DBS对TRD患者的认知没有持久的积极或消极影响。星形外科手术可能会对言语记忆产生暂时的负面影响。
Background. Preliminary studies report no negative and a possible positive impact of deep brain stimulation (DBS) on cognition of patients with treatment-resistant depression (TRD). However, these studies neither controlled for practice effects nor compared active with sham stimulation.Method. To address these limitations, we compared 25 TRD patients, who underwent DBS of the ventral anterior limb of the internal capsule (vALIC), with 21 healthy controls (HCs) matched on gender, age and education level. Both groups did subtests of the Cambridge Neuropsychological Test Automated Battery assessing verbal and visuospatial memory, attention, cognitive flexibility, psychomotor functioning, planning and object naming. TRD patients were tested 3 weeks prior to DBS surgery (baseline), 3 weeks following surgery (T1) and following 52 weeks of DBS optimization (T2). HCs were tested at baseline, 6 weeks following baseline (T1) and 20-24 weeks following baseline (T2). Subsequently, TRD patients entered a randomized, double-blind crossover phase, in which they were tested in an active and a sham stimulation phase.Results. TRD patients did not improve on a test of immediate verbal recognition from baseline to T1, whereas HCs did (group x time: p = 0.001). Both TRD patients and HCs improved over sessions on tests measuring delayed verbal recall, visuospatial memory, planning and object naming (all p < 0.01). Active and sham stimulation did not have an impact on any of the tests differentially.Conclusions. vALIC DBS neither has a lasting positive nor negative impact on cognition in TRD patients. DBS surgery might have a temporary negative effect on verbal memory.