Deep Brain Stimulation for Parkinson’s Disease: Association between Stimulation Parameters and Cognitive Performance

Abstract

Chronic subthalamic nucleus stimulation produces inconsistent patterns of cognitive change in Parkinson’s disease patients. Individually tailored stimulation parameters may contribute to this variable pattern of change. Systematic variation of amplitude, pulse width, and rate of stimulation has been reported to produce unique changes in motor and limbic response. To evaluate the association between stimulation parameters and cognitive/behavioral response, neuropsychological performance and stimulation parameter data of 8 Parkinson’s disease patients were submitted to Pearson r correlation analysis. Results indicate that each stimulation parameter was significantly associated with a subset of measures. The current findings raise the possibility that adverse cognitive/behavioral responses may be treated through parameter modification while maintaining motor symptom efficacy.

Deep Brain Stimulation Parameters Associated with Neuropsychological Changes in Subthalamic Nucleus Stimulation for Refractory Parkinson’s Disease

“…The clinical implications of these data argue that neuropsychological function, as measured by the RBANS, may be differentially affected by DBS parameters, particularly amplitude (voltage) and pulse width. This study extends the findings of Wojtecki et al [20] and Francel et al [34] and suggests that higher amplitude and longer pulse width were associated with improved memory and visuoconstructional skills as measured by the RBANS. Interestingly, this study mirrors data obtained for motor function [18,19] , in which increasing amplitude and pulse width were associated with improved motor function.…”

“…First, as with other studies of DBS and cognitive effects [21][22][23][24][25][26][27][28][29][30][31][32][33][34] , this study's power is limited by small sample size. In addition, the study design was correlational, and DBS parameters were not systematically varied during a participant's postsurgical assessment visit.…”

“…Wojtecki et al [20] studied affect of DBS frequency among 12 patients with PD and STN DBS, and found verbal fluency test scores were better with lower frequency (10 Hz) than higher frequency (130 Hz) DBS. Relatedly, Francel et al [34] reported significant correlations between STN DBS electrical settings and neuropsychological measures in 8 patients with idiopathic PD after STN DBS. In addition, speech intelligibility of patients with PD following STN DBS was found to be adversely affected by increasing stimulation parameters [35] .…”

“…Despite the clear relationship of stimulation parameters on motor function [18][19][20], little data has explored the relationship of stimulation parameters on cognitive function [20,25,[34][35] . Wojtecki et al [20] studied affect of DBS frequency among 12 patients with PD and STN DBS, and found verbal fluency test scores were better with lower frequency (10 Hz) than higher frequency (130 Hz) DBS.…”

Neuropsychological outcomes from deep brain stimulation—stimulation versus micro-lesion

“…There have been an increasing number of investigations regarding the effects of various specific stimulation parameters on both motor and non-motor symptoms. Earlier studies illustrated higher amplitude stimulation corresponded to decreased attention while increased pulse width improved delayed memory (9). Comparisons of different rates of STN stimulation have shown that high frequency stimulation (130 Hz or higher) worsened verbal fluency while low frequency stimulation (less than 130 Hz) appeared to improve verbal fluency (10).…”