Deep Brain Stimulation of the Subthalamic Nucleus Improves Cognitive Flexibility but Impairs Response Inhibition in Parkinson Disease

Abstract

Short-term STN stimulation improves cognitive flexibility (giving up habitual responses) but impairs response inhibition. Long-term STN stimulation does not change global cognitive function.

Deep brain stimulation in Parkinson disease—what went wrong?

“…This suggests that the inhibition of normal behaviour related to obsessions and compulsions on the one hand and impulsivity on the other might be on opposite sides of a behavioural spectrum. STN DBS in PD induces cognitive impulsivity, but at the same time improves cognitive flexibility [40,49] and speeds up decisions under high-conflict conditions [107], so we propose that cognitive-behavioural disinhibition might help in improving the incapacity to make a decision because of permanent doubt, which is a core feature of OCD. Although OCD seems as an area of high potential application of DBS, clinical trials are needed to reach conclusions regarding the best anatomical target site for this condition.…”

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

“…Verbal fluency and cognition problems are more often seen in old patients (Hariz et al, 2000;Saint-Cyr et al, 2000;Funkiewiez et al, 2004;Smeding et al, 2011), or in those with poor cognition or depression at baseline (De Gaspari et al, 2006). Specific cognition deficits include impairments of working memory (Saint-Cyr et al, 2000;Higginson et al, 2009;Okun et al, 2009), cognitive processing, visuo-spatial skills and setshifting (Saint-Cyr et al, 2000;Alegret et al, 2001), response inhibition (Witt et al, 2004), or the decoding of facial expressions (Dujardin et al, 2004;Schroeder et al, 2004;Biseul et al, 2005;Drapier et al, 2008). Even when present, the impact of changes in verbal fluency on the quality of life appears to be relatively small (Alegret et al, 2004;Morrison et al, 2004;Montel and Bungener, 2009;Zahodne et al, 2009).…”

Therapeutic High-Frequency Stimulation of the Subthalamic Nucleus in Parkinson's Disease Produces Global Increases in Cerebral Blood Flow

“…In PD, STN-DBS significantly improves tremor, rigidity, and bradykinesia, often allows a significant reduction in the therapeutic doses of medication thereby reducing dyskinesias, and is associated with improvements in activities of daily living and quality of life. The most common cognitive sequelae of STN-DBS seem to be a period of postoperative confusion (Benabid et al, 2009) in some individuals and reduced performance on tests of verbal fluency, although this is not a consistent finding (Witt et al, 2004;Parsons et al, 2006).…”