Cognitive Impact of Deep Brain Stimulation in Parkinson’s Disease Patients: A Systematic Review

Abstract

IntroductionParkinson’s disease (PD) patients have a significantly higher risk of developing dementia in later disease stages, leading to severe impairments in quality of life and self-functioning. Questions remain on how deep brain stimulation (DBS) affects cognition, and whether we can individualize therapy and reduce the risk for adverse cognitive effects. Our aim in this systematic review is to assess the current knowledge in the field and determine if the findings could influence clinical practice.MethodsWe have conducted a systematic review according to PRISMA guidelines through MEDLINE and Embase databases, with studies being selected for inclusion via a set inclusion and exclusion criteria.ResultsSixty-seven studies were included in this systematic review according to the selected criteria. This includes 6 meta-analyses, 18 randomized controlled trials, 17 controlled clinical trials, and 26 observational studies with no control arms. The total number of PD patients encompassed in the studies cited in this review is 3677, not including the meta-analyses.ConclusionCognitive function in PD patients can deteriorate, in most cases mildly, but still impactful to the quality of life. The strongest evidence is present for deterioration in verbal fluency, while inconclusive evidence is still present for executive function, memory, attention and processing speed. Global cognition does not appear to be significantly impacted by DBS, especially if cognitive screening is performed prior to the procedure, as lower baseline cognitive function is connected to poor outcomes. Further randomized controlled studies are required to increase the level of evidence, especially in the case of globus pallidus internus DBS, pedunculopontine nucleus DBS, and the ventral intermediate nucleus of thalamus DBS, and more long-term studies are required for all respective targets.

A Computational Model of Deep Brain Stimulation for Parkinson’s Disease Tremor

“…While DBS effectively attenuates motor symptoms, concerns persist regarding its impact on cognitive function. Existing studies have yet to fully elucidate the precise role of DBS within basal ganglia subcortical structures in alleviating Parkinsonian symptoms and the underlying mechanisms driving cognitive decline [79], [80].…”

Estimulação cerebral profunda como tratamento na doença de Parkinson

“…Além disso, tem sido utilizada no tratamento de síndromes dolorosas como dor neuropática, cefaleia em salvas e está sob investigação para diversas outras doenças resistentes ao tratamento convencional, como Alzheimer, Síndrome de Tourette, anorexia e esquizofrenia (KOKKONEN et al, 2022;KRAUSS et al, 2020). Ademais, a ECP é comumente empregada para tratar os sintomas motores da DP (RACKI et al, 2022).…”

Structural and microstructural predictors of cognitive decline in deep brain stimulation of subthalamic nucleus in Parkinson’s disease

“…Lower baseline cognitive performance has been previously associated with worse outcomes of STN DBS ( Gruber et al, 2019 , Witt et al, 2011 ), even though these findings have been challenged ( Floden et al, 2015 ). Moreover, there is a bidirectional aspect to the association between cognition and STN DBS – meta -analyses comparing STN DBS and pharmacotherapy have pointed to mild, but statistically significant cognitive decline in PD patients treated with STN DBS ( Combs et al, 2015 , Xie et al, 2016 ), even though multiple randomized controlled clinical trials and observational studies reported no substantial changes in global cognitive performance ( Rački et al, 2022 ).…”