Effects of Bilateral Subthalamic Stimulation on Cognitive Function in Parkinson Disease

Alegret, Montserrat; Junqué, Carme; Valldeoriola, Francesc; Vendrell, Pere; Pilleri, Manuela; Rumià, Jordi; Tolosa, Eduardo

doi:10.1001/archneur.58.8.1223

Cited by 220 publications

(172 citation statements)

References 33 publications

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“…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).…”

Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

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

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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Section: Non-motor Side Effects Of Stn and Gpi-dbsmentioning

confidence: 99%

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

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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“…Effects of STN‐DBS in cognition and behavior have been analyzed in many studies. The effects of STN‐DBS have been studied with findings ranging from no significant changes in cognition and behavior to mild increase in anxiety and worsening of some cognitive functions (Alegret et al., 2001; Saint‐Cyr, Trépanier, Kumar, Lozano, & Lang, 2000). Some studies found mild improvement in mood such as anxiety and depressive symptoms, but no changes in cognitive performance (Witt et al., 2008).…”

Section: Introductionmentioning

confidence: 99%

l‐Dopa/carbidopa intestinal gel and subthalamic nucleus stimulation: Effects on cognition and behavior

et al. 2017

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ObjectiveIn Parkinson's disease (PD), effects on behavior and cognition of levodopa/carbidopa intestinal gel (LCIG) and subthalamic stimulation (STN‐DBS) and their practical consequences remain controversial. This study was designed to analyze the possible effects of these therapies on cognition and behavior after 1 year follow‐up.MethodsThis was an open‐label, nonrandomized prospective study for pre‐ and postintervention analyses. Twenty‐four patients were considered eligible to be candidates for complex therapies such as STN‐DBS or LCIG; 23 patients treated with standard medication were included as controls. Several cognitive, behavioral, and motor scales were administered before and at 6 and 12 months after the intervention.ResultsPatients treated with LCIG experienced significant improvement in specific neuropsychological functions when compared with patients receiving STN‐DBS and conventional medical treatment after 1 year from the onset of the intervention. In this study, no significant cognitive or behavioral changes occurred in patients treated with subthalamic stimulation when compared to patients receiving conventional medical treatment at 1 year follow‐up.ConclusionsPatients treated with LCIG may significantly improve some specific neuropsychological functions when compared with patients receiving STN‐DBS and with patients receiving conventional medical treatment after 1 year from the intervention; there are not significant cognitive or behavioral changes in patients treated with STN‐DBS when compared to PD patients receiving conventional medical treatment after 1 year from the intervention. The outcomes showed in the study can help to the selection of the appropriate candidates for STN‐DBS and LCIG.

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“…16,17,37,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Even among studies reporting more widespread cognitive declines there is disagreement as to the clinical meaningfulness of these changes. Alegret and co-workers 35 interpreted the changes not to be of clinical significance, in contrast to Saint-Cyr et al 38 and Smeding et al 39 As many of the neuropsychological studies of STN DBS have small sample sizes, greater weight should be given to the five controlled neuropsychological studies (excluding studies limited to language or cognitive screening evaluations), even though each has significant methodological and/or conceptual limitations. The first controlled neuropsychological study of STN DBS 45 compared outcomes in eight patients with bilateral STN DBS, eight patients undergoing unilateral pallidotomy and eight unoperated PD patients.…”

Section: Pallidal Deep Brain Stimulationmentioning

confidence: 95%

“…29 Most studies employing formal neuropsychological evaluations have been uncontrolled and used fairly small samples, and methodological limitations of these studies have been reviewed. [30][31][32][33][34] These studies, with few exceptions, 20,[35][36][37][38][39] have observed small and circumscribed cognitive changes, most often in verbal fluency (timed oral word generation according to different phonemic or semantic constraints). 16,17,37,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Even among studies reporting more widespread cognitive declines there is disagreement as to the clinical meaningfulness of these changes.…”

Section: Pallidal Deep Brain Stimulationmentioning

confidence: 99%

Effects of Deep Brain Stimulation on Cognition, Mood and Behaviour in Parkinson’s Disease

Tröster¹

2008

European Neurological Review

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32Disappointed by the limitations of pharmacotherapy, emboldened by technological advances in surgery and radiology and armed with a better understanding of pathophysiology, physicians and scientists in the 1980s charted a renaissance of surgery for movement disorders such as Parkinson's disease (PD). The desire for a safer alternative to lesional or ablative neurosurgery, coupled with observations that intraoperative electrical stimulation used for target identification could alleviate abnormal movements, 1,2 prompted the exploration of fully Neurobehavioural Effects of Deep Brain Stimulation in Parkinson's DiseaseBy far the most attention to neurobehavioural outcomes of DBS has been devoted to PD, and the majority of these studies have examined the outcome of subthalamic (STN) rather than thalamic or pallidal (GPi) DBS. Probably greater controversy attends the neurobehavioural outcomes after STN DBS than after GPi or thalamic DBS, and this probably reflects, at least in part, differences among studies in the sample characteristics, selection and exclusion criteria, length of follow-up, surgical technique, post-operative DBS programming and pharmacotherapy protocols, and the thoroughness and timing of the neuropsychological evaluation protocol. In general, studies employing cognitive screening instruments fail to detect neurobehavioural morbidity. While some may argue that the lack of change on screening instruments suggests that neuropsychological changes detected by more extensive evaluations are not of clinical significance, a recent meta-analysis of the empirical data suggests that screening instruments may be insensitive even to clinically meaningful changes after DBS. 8 Consequently, cognitive screening measures are probably useful in helping decide which surgical candidates can be excluded from further evaluation (including full neuropsychological evaluation), but insufficient to adequately document neurobehavioural outcomes of DBS. Thalamic Deep Brain StimulationFour studies 9-12 have observed no widespread or significant changes in cognition, mood or behaviour after unilateral thalamic DBS, although one study suggested that statistically (but not necessarily clinically) significant declines in verbal memory are associated with left thalamic DBS. Few studies have examined mood after thalamic DBS, but one study 9 found an improvement in depressive symptoms four to 10 days after surgery. Pallidal Deep Brain StimulationUnilateral GPi DBS appears cognitively safe, although this conclusion is tempered by the limited number of small-sample studies published. [13][14][15] Although patients in one study showed statistically significant declines in visuoconstructional ability and verbal fluency, the changes were rarely of clinical significance. Even when using a liberal criterion of impairment (a test score falling one standard deviation below the mean of normative samples), another study 13 observed that only six of the 20 patients showed any increase, no matter how small, in the percentage of tests in the imp...

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Effects of Bilateral Subthalamic Stimulation on Cognitive Function in Parkinson Disease

Abstract: Therapy with STN-DBS improves motor symptoms in PD without any clinically relevant neuropsychological deterioration.

Cited by 220 publications

References 33 publications

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

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

l‐Dopa/carbidopa intestinal gel and subthalamic nucleus stimulation: Effects on cognition and behavior

Effects of Deep Brain Stimulation on Cognition, Mood and Behaviour in Parkinson’s Disease

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