Cognition following bilateral deep brain stimulation surgery of the subthalamic nucleus for Parkinson's disease

Halpern, Casey H.; Rick, Jacqueline; Danish, Shabbar F.; Grossman, Murray; Baltuch, Gordon H.

doi:10.1002/gps.2149

Cited by 57 publications

(40 citation statements)

References 68 publications

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“…Despite favorable consequences, adverse effects in some cognitive traits are well known [1][2][3] . In search of these adverse effects, complex strategies were designed to better understand the underlining mechanism of stimulation.…”

Section: Introductionmentioning

confidence: 99%

No Effect of Different Stimulation Conditions on Verbal Fluency and Visuospatial Orientation in Patients with Subthalamic Nucleus Deep Brain Stimulation

Yılmaz

Akbostancı²,

Mercan³

et al. 2015

Stereotact Funct Neurosurg

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Background: Subthalamic nucleus deep brain stimulation is an effective treatment for the symptomatic treatment of Parkinson's disease. Apart from the obvious motor benefits, some cognitive side effects have been reported, particularly in verbal fluency. Objectives: Our aim was to evaluate the effects of the stimulation on verbal fluency and visuospatial orientation with changing stimulation conditions in 35 patients with Parkinson's disease. Methods: Patients were randomized for their stimulation conditions as ‘both on', ‘both off', ‘right on', and ‘left on' and underwent verbal fluency and visuospatial orientation tasks during their drug-on periods. Letter and categorical fluency tasks and Benton's Judgment of Line Orientation Test were used for assessment. Results: Overall, 6 patients were excluded due to dementia or depression. For verbal fluency, the number of words they produced in 1 min was similar in four stimulation conditions (p > 0.05). No significant difference was found between stimulation conditions in the spatial orientation task. Conclusions: We were unable to find any significant changes in verbal fluency and visuospatial orientation task scores with different stimulation conditions. This result suggests that either stimulation has no effect on given domains or the effect is so small that more detailed batteries are required to detect the difference.

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Section: Introductionmentioning

confidence: 99%

No Effect of Different Stimulation Conditions on Verbal Fluency and Visuospatial Orientation in Patients with Subthalamic Nucleus Deep Brain Stimulation

Yılmaz

Akbostancı²,

Mercan³

et al. 2015

Stereotact Funct Neurosurg

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“…Comparison of "on" and "off" conditions of stimulation suggest that these deficits could be partly due to electrode implantation through the frontal lobe, resulting in disruption of frontal-striatal-thalamic circuitry. 45 The lack of recovery in visual organization, visual memory and abstract reasoning after 8 months of stimulation in our study may indicate a persistent effect of surgery. The improvement in semantic verbal fluency and stabilization of abstract reasoning, however, could be due to several factors: a transient effect of surgical intervention, a positive effect of stimulation and/or an effect related to improvement in clinical symptoms.…”

Section: J Psychiatry Neurosci 2015;40(6)mentioning

confidence: 55%

Cognitive effects of deep brain stimulation in patients with obsessive–compulsive disorder

Mantione

Nieman

Figee

et al. 2015

J Psychiatry Neurosci

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IntroductionRecently, several studies have shown that deep brain stimulation (DBS) targeting the anterior limbs of the internal capsule, the ventral striatum, the nucleus accumbens (NAcc), the inferior thalamic peduncle and the subthalamic nucleus is effective in patients with treatment-refractory obsessivecompulsive disorder (OCD). [1][2][3][4][5][6][7][8][9] To date, the results of 7 controlled studies have been published worldwide and have reported that 34 of 63 patients experienced a reduction of at least 35% of OCD symptoms. Consequently, half of the treated patients can be considered responders, indicating that DBS is a promising technique. 10Neuropsychological evaluation in DBS treatment plays a vital role in preoperative neuropsychological screening of potential DBS candidates, in evaluation of outcome and in research.11 The contribution of neuropsychological assessment in research is 2-fold: it may establish the cognitive safety of DBS treatment and it may demonstrate whether DBS alters the underlying cognitive deficits in individuals with OCD. Presently, there is evidence that the clinical effectiveness of DBS in patients with OCD is achieved with stable [3][4][5][6][7][8]12,13 and even improved 14 cognitive functioning. However, since small sample sizes, lack of a control group and the use of a limited range of tests hinder the interpretation of the results, the effect of DBS on cognitive functioning in patients with OCD is still unknown.We conducted a prospective, controlled study investigating the cognitive effects of bilateral DBS targeted at the NAcc 3 weeks and 8 months postoperatively to examine its shortand long-term effects. In addition we investigated whether clinical changes after DBS treatment were associated with changes in cognitive functioning. Changes were compared at 3 time points with a matched control group of patients with treatment-refractory OCD who received conventional therapy. Background: Deep brain stimulation (DBS) is a promising treatment for treatment-refractory obsessive-compulsive disorder (OCD). However, the effects of DBS on cognitive functioning remain unclear. Therefore, we aimed to assess cognitive safety of DBS for treatment-refractory OCD and the association between clinical changes and cognitive functioning. Methods: Patients with treatmentrefractory OCD treated with DBS targeted at the nucleus accumbens (NAcc) were compared with a control group of 14 patients with treatment-refractory OCD treated with care as usual. We assessed cognitive functioning at baseline, 3 weeks postoperatively and following 8 months of DBS. We compared change in clinical symptoms with cognitive changes. Results: There were 16 patients in the DBS group and 14 patients in the control group. Three weeks postoperatively, the DBS group showed a significantly reduced performance on measures of visual organization and verbal fluency and a trend toward reduced performance on measures of visual memory and abstract reasoning. Cognitive functioning was found to be stable on all other measures. Afte...

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“…While impairment in cognition after STN-DBS is mild in most patients [Halpern et al 2009], patients with impaired attention, advanced age and a low levodopa response at baseline seem to be more vulnerable to cognitive decline after STN-DBS [Smeding et al 2011]. Thus cognition is slightly impaired after STN-DBS and a strict selection of appropriate patients for surgery may be useful to prevent worsening of cognition.…”

Section: Neuropsychiatric Dysfunctionmentioning

confidence: 99%

Nonmotor outcomes in Parkinson’s disease: is deep brain stimulation better than dopamine replacement therapy?

Borgohain¹,

Kandadai²,

Jabeen³

et al. 2011

Ther Adv Neurol Disord

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Nonmotor symptoms are an integral part of Parkinson's disease and cause significant morbidity. Pharmacological therapy helps alleviate the disease but produces nonmotor manifestations. While deep brain stimulation (DBS) has emerged as the treatment of choice for motor dysfunction, the effect on nonmotor symptoms is not well known. Compared with pharmacological therapy, bilateral subthalamic nucleus (STN)-DBS or globus pallidum interna (GPi)-DBS has significant beneficial effects on pain, sleep, gastrointestinal and urological symptoms. STN-DBS is associated with a mild worsening in verbal fluency while GPi-DBS has no effect on cognition. STN-DBS may improve cardiovascular autonomic disturbances by reducing the dose of dopaminergic drugs. Because the motor effects of STN-DBS and GPi-DBS appear to be similar, nonmotor symptoms may determine the target choice in surgery of future patients.Keywords: Parkinson's disease, deep brain stimulation, dopaminergic drugs, globus pallidum interna deep brain stimulation, nonmotor symptoms, pharmacological therapy, subthalamic nucleus deep brain stimulation IntroductionThe pathology of Parkinson's disease (PD) extends far beyond the nigrostriatal system and results in nonmotor symptoms coexisting with motor symptoms. Nonmotor symptoms can precede motor symptoms by years and are common in all stages of PD.They cause significant morbidity [Lim and Lang, 2010] and are often under recognized by health professionals [Parsons et al. 2006]. They can be divided into four domains: neuropsychiatric, autonomic, sleep and sensory dysfunction [Lim and Lang, 2010].

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Cognition following bilateral deep brain stimulation surgery of the subthalamic nucleus for Parkinson's disease

Abstract: While cognitive decline has been observed in some domains, our review of the data suggests that STN DBS is a worthwhile and safe method to treat PD.

Cited by 57 publications

References 68 publications

No Effect of Different Stimulation Conditions on Verbal Fluency and Visuospatial Orientation in Patients with Subthalamic Nucleus Deep Brain Stimulation

No Effect of Different Stimulation Conditions on Verbal Fluency and Visuospatial Orientation in Patients with Subthalamic Nucleus Deep Brain Stimulation

Cognitive effects of deep brain stimulation in patients with obsessive–compulsive disorder

Nonmotor outcomes in Parkinson’s disease: is deep brain stimulation better than dopamine replacement therapy?

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