Neuropsychological and quality of life assessment in patients with Parkinson's disease submitted to bilateral deep brain stimulation in the subthalamic nucleus

Abstract

Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms.ObjectiveTo evaluate the influence of DBS in the STN on cognition, mood and quality of life.MethodsWe studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test.ResultsA total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale.ConclusionDBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood.

Deep brain stimulation: Challenges at the tissue‐electrode interface and current solutions

“…7 Targeting the STN significantly improves mobility, activities of daily life, and quality of life. 8,9 Placement of the DBS electrode is of importance for determining therapeutic effects since the STN has three parts, which form loops for somatosensory, associative, and limbic functions. In a single center study, one hundred and three patients with severe PD received bilateral STN stimulation and were followed up after 1 year.…”

“…The subthalamic nucleus (STN) is the most popular target for DBS in PD 7 . Targeting the STN significantly improves mobility, activities of daily life, and quality of life 8,9 . Placement of the DBS electrode is of importance for determining therapeutic effects since the STN has three parts, which form loops for somatosensory, associative, and limbic functions.…”

A Review of Cognitive Outcomes Across Movement Disorder Patients Undergoing Deep Brain Stimulation

“…DBS patients exhibited deteriorations after surgery compared to preoperative performances in tasks of verbal fluency (59–77), memory (59, 62, 64, 66–68, 71, 72, 75, 77), executive function (59, 60, 64, 67, 69, 71, 72, 76–80), attention (66, 71), visuospatial functioning (59, 72, 75), global cognition (62, 74, 78), abstract reasoning (62), and processing speed (64, 72, 76, 77). A few studies observed no cognitive changes up to 3 months (81), in which individuals who did decline were significantly older, had higher levels of levodopa at baseline, and all had left implants in the GPi, up to 6 months (82, 83), and up to 5 years (84), in which there was a trend for a decline in verbal fluency. Within other studies, the outcomes of verbal fluency were variable.…”