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

Abstract

Background/Aims: Parkinson’s disease (PD) is an idiopathic progressive neurological disorder. Improvement in motor function of PD patients has been established with subthalamic nucleus (STN) deep brain stimulation (DBS). While variations in DBS settings (i.e. amplitude, frequency and pulse width) on motor function have been explored, little data has evaluated the relationship of DBS settings on cognitive function. This study evaluated the extent to which DBS settings were associated with cognitive function. Methods: The study was a prospective clinical trial of STN DBS for the treatment of refractory PD. Twenty patients were evaluated once preoperatively and an average of 5 months following bilateral STN DBS. Measures included a test of motor disability, a neuropsychological test battery and subjective mood measures of anxiety and depression. Results: Motor function significantly improved following bilateral STN DBS. Compared to preoperative performance, verbal fluency declined while visuoconstructional skills improved. Amplitude and pulse width were significantly correlated with measures of cognitive function. Multiple regression found DBS stimulator settings, along with anxiety, to be significant predictors of cognitive measures. Conclusion: Increased amplitude and pulse width and decreased anxiety were associated with improved cognitive test scores. Although preliminary, these data have potential theoretical and clinical applications.

The effects of subthalamic deep brain stimulation on metaphor comprehension and language abilities in Parkinson’s disease

“…Contrary to our hypothesis and to results from previous studies (Phillips et al, 2012;Schoenberg et al, 2008;Wojtecki et al, 2006), electrical stimulation of the STN did not negatively affect the language abilities evaluated in this study.…”

“…Some studies have reported a decrease in executive functions and memory after STN-DBS (Fasano et al, 2010;Klempířová et al, 2007;Saint-Cyr, Trépanier, Kumar, Lozano, & Lang, 2000;Smeding, Speelman, Huizenga, Schuurman, & Schmand, 2011) while others have observed an improvement in executive abilities (Daniele et al, 2003;Schoenberg, Mash, Bharucha, Francel, & Scott, 2008;Temel et al, 2006). Despite these divergent results, a meta-analysis completed by Parsons, Rogers, Braaten, Woods, and Tröster (2006) demonstrated a significant (but small) deterioration in executive functions and memory following STN-DBS.…”

“…In studies exploring the effects of STN-DBS on language, verbal fluency was certainly the most investigated ability. Most of these studies reported a deterioration in verbal fluency after surgery (Schoenberg et al, 2008;Wojtecki et al, 2006). This deterioration was observed a few months after surgery, suggesting that this effect could be caused by the implantation of electrodes (Morrison et al, 2004).…”

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

“…Eleven of them 3,22,36,52,61,67,69,70,73,76,78 presented data in a non-comparable way, with a total of 52 references allowing quantitative analysis.…”

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

“…With respect to DBS, some studies have shown that this technique is also associated with gains in memory 164,165 . Parameters such as amplitude and pulse width are associated with improvement in cognitive performance 166 . On the other hand, some authors have shown negative effects related to functions such as verbal fluency and attention 165,167 .…”