The impact of white matter lesions on the cognitive outcome of subthalamic nucleus deep brain stimulation in Parkinson’s disease

Blume, Josefine; Lange, Max; Rothenfusser, Eva; Doenitz, Christian; Bogdahn, Ulrich; Brawanski, Alexander; Schlaier, J.

doi:10.1016/j.clineuro.2017.05.023

Cited by 15 publications

(8 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Change OK?] -according to outcomes in clinical series -people with PD who are younger than 70-75 years, have a good motor response to levodopa, have little or no medical or psychiatric comorbidity and have no major abnormalities on pre-operative MRI brain scans 57 , but who have some degree of disability (usually motor fluctuations or dyskinesia) that are refractory to adjustments of non-invasive therapies. Within these broad criteria, some patients are presumably likely to have better long-term outcomes than others, and identifying the factors that predict who these patients are would be helpful.…”

Section: [H1] Current and Future Clinical Implicationsmentioning

confidence: 99%

Long-term outcomes of deep brain stimulation in Parkinson disease

2019

View full text Add to dashboard Cite

| The efficacy of deep brain stimulation (DBS) for Parkinson disease (PD) is well established for up to 1 or 2 years, but long-term outcome data are still limited. In this Review, we critically discuss the evidence on the long-term outcomes of DBS and consider the clinical implications. Although many patients are lost to follow-up, the evidence indicates that subthalamic nucleus DBS improves motor function for up to 10 years, although the magnitude of improvement tends to decline over time. Functional scores recorded during onmedication periods worsen faster than those recorded in off periods, consistent with the degeneration of non-dopaminergic pathways. Dyskinesia, motor fluctuations and activities of daily living in off periods remain improved at 5 years, but quality of life scores have usually fallen below pre-operative levels.The incidence and severity of dementia among patients receiving DBS are comparable to those among patients who receive medical treatment. Severe adverse events are rare, but adverse events such as dysarthria are common and probably under-reported. Long-term data on the outcomes of globus pallidus interna DBS are limited and mostly confirm the efficacy for dyskinesia. A trend towards offering DBS in the earlier stages of PD creates a need to identify factors that predict long-term outcomes and to discuss realistic expectations with patients pre-operatively.

show abstract

Section: [H1] Current and Future Clinical Implicationsmentioning

confidence: 99%

Long-term outcomes of deep brain stimulation in Parkinson disease

2019

View full text Add to dashboard Cite

show abstract

“…Patients who developed PD-D had a higher volume of WML at baseline compared to non-demented patients. Likewise, a worsening of CSS was correlated to the volume of WML after correction for age in a linear regression analysis (93). This study demonstrated that declines in cognition could be influenced by several factors.…”

Section: Parkinson's Diseasementioning

confidence: 99%

A Review of Cognitive Outcomes Across Movement Disorder Patients Undergoing Deep Brain Stimulation

2019

View full text Add to dashboard Cite

Introduction: Although the benefit in motor symptoms for well-selected patients with deep brain stimulation (DBS) has been established, cognitive declines associated with DBS can produce suboptimal clinical responses. Small decrements in cognition can lead to profound effects on quality of life. The growth of indications, the expansion of surgical targets, the increasing complexity of devices, and recent changes in stimulation paradigms have all collectively drawn attention to the need for re-evaluation of DBS related cognitive outcomes. Methods: To address the impact of cognitive changes following DBS, we performed a literature review using PubMed. We searched for articles focused on DBS and cognition. We extracted information about the disease, target, number of patients, assessment of time points, cognitive battery, and clinical outcomes. Diseases included were dystonia, Tourette syndrome (TS), essential tremor (ET), and Parkinson's disease (PD). Results: DBS was associated with mild cognitive issues even when rigorous patient selection was employed. Dystonia studies reported stable or improved cognitive scores, however one study using reliable change indices indicated decrements in sustained attention. Additionally, DBS outcomes were convoluted with changes in medication dose, alleviation of motor symptoms, and learning effects. In the largest, prospective TS study, an improvement in attentional skills was noted, whereas smaller studies reported variable declines across several cognitive domains. Although, most studies reported stable cognitive outcomes. ET studies largely demonstrated deficits in verbal fluency, which had variable responses depending on stimulation setting. Recently, studies have focused beyond the ventral intermediate nucleus, including the post-subthalamic area and zona incerta. For PD, the cognitive results were heterogeneous, although deficits in verbal fluency were consistent and related to the micro-lesion effect. Conclusion: Post-DBS cognitive issues can impact both motor and quality of life outcomes. The underlying pathophysiology of cognitive changes post-DBS and the identification of pathways underpinning declines will require further investigation. Future studies should employ careful methodological designs. Patient specific analyses will be helpful to differentiate the effects of medications, DBS and the underlying disease state, including disease progression. Disease progression is often an underappreciated factor that is important to post-DBS cognitive issues.

show abstract

“…For example, Blume et al . [ 19 ] found that, in Parkinson's disease, a higher WML volume was associated with the rapid onset of dementia within the 1 st year of treatment with deep brain stimulation. In contrast, a previous study failed to find a relationship between total WML volume and MMSE performance.…”

Section: W Hite M Atter L mentioning

confidence: 99%

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Yang

Dong

Lyu

et al. 2018

Chinese Medical Journal

View full text Add to dashboard Cite

Objective:Alzheimer's disease and vascular dementia are responsible for more than 80% of dementia cases. These two conditions share common risk factors including hypertension. Cerebral small vessel disease (CSVD) is strongly associated with both hypertension and cognitive impairment. In this review, we identify the pathophysiological changes in CSVD that are caused by hypertension and further explore the relationship between CSVD and cognitive impairment.Data Sources:We searched and scanned the PubMed database for recently published literatures up to December 2017. We used the keywords of “hypertension”, “cerebral small vessel disease”, “white matter lesions”, “enlarged perivascular spaces”, “lacunar infarcts”, “cerebral microbleeds”, and “cognitive impairment” in the database of PubMed.Study Selection:Articles were obtained and reviewed to analyze the hypertension-induced pathophysiological changes that occur in CSVD and the correlation between CSVD and cognitive impairment.Results:In recent years, studies have demonstrated that hypertension-related changes (e.g., small vascular lesions, inflammatory reactions, hypoperfusion, oxidative stress, damage to autoregulatory processes and the blood-brain barrier, and cerebral amyloid angiopathy) can occur over time in cerebral small vessels, potentially leading to lower cognitive function when blood pressure (BP) control is poor or lacking. Both isolated and co-occurrent CSVD can lead to cognitive deterioration, and this effect may be attributable to a dysfunction in either the cholinergic system or the functionality of cortical and subcortical tracts.Conclusions:We explore the currently available evidence about the hypertensive vasculopathy and inflammatory changes that occur in CSVD. Both are vital prognostic indicators of the development of cognitive impairment. Future studies should be performed to validate the relationship between BP levels and CSVD progression and between the numbers, volumes, and anatomical locations of CSVD and cognitive impairment.

show abstract

The impact of white matter lesions on the cognitive outcome of subthalamic nucleus deep brain stimulation in Parkinson’s disease

Cited by 15 publications

References 28 publications

Long-term outcomes of deep brain stimulation in Parkinson disease

Long-term outcomes of deep brain stimulation in Parkinson disease

A Review of Cognitive Outcomes Across Movement Disorder Patients Undergoing Deep Brain Stimulation

Hypertension-Induced Cerebral Small Vessel Disease Leading to Cognitive Impairment

Contact Info

Product

Resources

About