Cognitive and behavioural effects of chronic stimulation of the subthalamic nucleus in patients with Parkinson's disease.

Full Abstract

OBJECTIVE:
To investigate cognitive and behavioural effects of bilateral lead implants for high frequency stimulation (HFS) of the subthalamic nucleus in patients with Parkinson's disease; and to discriminate between HFS and the effects of surgical intervention on cognitive function by carrying out postoperative cognitive assessments with the stimulators turned on or off.

METHODS:
Motor, cognitive, behavioural, and functional assessments were undertaken in 20 patients with Parkinson's disease before implantation and then at three, six, and 12 months afterwards. Nine patients were also examined 18 months after surgery. Postoperative cognitive assessments were carried out with stimulators turned off at three and 18 months, and turned on at six and 12 months.

RESULTS:
Cognitive assessment showed a significant postoperative decline in performance on tasks of letter verbal fluency (across all postoperative assessments, but more pronounced at three months) and episodic verbal memory (only at three months, with stimulators off). At three, six, and 12 months after surgery, there was a significant improvement in the mini-mental state examination and in a task of executive function (modified Wisconsin card sorting test). On all postoperative assessments, there was an improvement in parkinsonian motor symptoms, quality of life, and activities of daily living while off antiparkinsonian drugs. A significant postoperative decrease in depressive and anxiety symptoms was observed across all assessments. Similar results were seen in the subgroup of nine patients with an 18 month follow up. Following implantation, three patients developed transient manic symptoms and one showed persistent psychic akinesia.

CONCLUSIONS:
Bilateral HFS of the subthalamic nucleus is a relatively safe procedure with respect to long term cognitive and behavioural morbidity, although individual variability in postoperative cognitive and behavioural outcome invites caution. Stimulation of the subthalamic nucleus does not per se appear to impair cognitive performance in patients with Parkinson's disease and may alleviate the postoperative decline in verbal fluency.

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Author information

Author/s: Daniele, A (A); Albanese, A (A); Contarino, M F (MF); Zinzi, P (P); Barbier, A (A); Gasparini, F (F); Romito, L M A (LM); Bentivoglio, A R (AR); Scerrati, M (M);

Affiliation: Istituto di Neurologia, Università Cattolica, Largo A Gemelli 8, I-00168 Rome, Italy. adaniele(-atsign-)rm.unicatt.it

Journal and publication information

Publication Type: Journal Article

Journal: Journal of neurology, neurosurgery, and psychiatry (J Neurol Neurosurg Psychiatry), published in England. (Language: eng)

Reference: 2003-Feb; vol 74 (issue 2) : pp 175-82

Dates: Created 2003/01/17; Completed 2003/02/26; Revised 2008/11/20;

PMID: 12531943, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Cognition Disorders - diagnosis; physiopathology; therapy
Disability Evaluation
Dominance, Cerebral - physiology
Electric Stimulation Therapy
Female
Follow-Up Studies
Humans
Male

Male
Middle Aged
Neurologic Examination
Neuropsychological Tests
Outcome and Process Assessment (Health Care)
Parkinson Disease - diagnosis; physiopathology; therapy
Social Behavior Disorders - diagnosis; physiopathology; therapy
Subthalamic Nucleus - physiopathology
Verbal Behavior - physiology

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