Differential cognitive effects of unilateral left and right subthalamic nucleus deep brain stimulation for Parkinson disease

Abstract

ObjectiveTo investigate hemispheric effects of directional versus ring subthalamic nucleus (STN) deep brain stimulation (DBS) surgery on cognitive function in patients with advanced Parkinson’s disease (PD).MethodsWe examined 31 PD patients (Left STN n = 17; Right STN n = 14) who underwent unilateral subthalamic nucleus (STN) DBS as part of a NIH-sponsored randomized, cross-over, double-blind (ring vs directional) clinical trial. Outcome measures were tests of verbal fluency, auditory-verbal memory, and response inhibition. First, all participants were pooled together to study the effects of directional versus ring stimulation. Then, we stratified the groups by surgery hemisphere and studied the longitudinal changes in cognition post-unilateral STN DBS.ResultsRelative to pre-DBS cognitive baseline performances, there were no group changes in cognition following unilateral DBS for either directional or ring stimulation. However, assessment of unilateral DBS by hemisphere revealed a different pattern. The left STN DBS group had lower verbal fluency than the right STN group (t(20.66 = -2.50,p= 0.02). Over a period of eight months post-DBS, verbal fluency declined in the left STN DBS group (p= 0.013) and improved in the right STN DBS group over time (p< .001). Similarly, response inhibition improved following right STN DBS (p= 0.031). Immediate recall did not significantly differ over time, nor was it affected by implant hemisphere, but delayed recall equivalently declined over time for both left and right STN DBS groups (left STN DBSp= 0.001, right STN DBS differ from left STN DBSp= 0.794).ConclusionsDirectional and ring DBS did not differentially or adversely affect cognition over time. Regarding hemisphere effects, verbal fluency decline was observed in those who received left STN DBS, along with the left and right STN DBS declines in delayed memory. The left STN DBS verbal fluency decrement is consistent with prior bilateral DBS research, likely reflecting disruption of the basal-ganglia-thalamocortical network connecting STN and inferior frontal gyrus. Interestingly, we found an improvement in verbal fluency and response inhibition following right STN DBS. It is possible that unilateral STN DBS, particularly in the right hemisphere, may mitigate cognitive decline.

Reversible Micrographia in Association with STN-DBS Therapy in a Patient with Parkinson’s Disease

“…The deterioration in the verbal fluency, a measure of language function, is shown to occur particularly in patients with left hemisphere stimulation. [ 11 ] Of note, handwriting is not only a motor task, but additionally requires the function of intact language functions. Although we did not evaluate the pre- and post-DBS assessments of language functions, we can hypothesize that the left stimulation of STN-DBS might lead to micrographia by affecting the particular language areas localized in the left hemisphere via its possible effect in the hyperdirect pathway.…”