Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease
Identifieur interne : 002984 ( Istex/Corpus ); précédent : 002983; suivant : 002985Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease
Auteurs : Jean A. Saint-Cyr ; Lisa L. Tre Panier ; Rajeev Kumar ; Andres M. Lozano ; A. E. LangSource :
- Brain [ 0006-8950 ] ; 2000-10.
English descriptors
- KwdEn :
- ADL = activities of daily living, BEM = Batterie d'efficience mnésique, CALT = Conditional Associative Learning Test, CVLT = California Verbal Learning Test, DBS = deep brain stimulation, FLOPS = Frontal Lobe Personality Scale, GDI = Geriatric Depression Inventory, GPi = globus pallidus, internal segment, PASAT = Paced Auditory Serial Addition Test, PSP = Progressive Supranuclear Palsy, PVP = posteroventral pallidotomy, Parkinson's disease, SMA = supplementary motor area, STN = subthalamic nucleus, TMT = Trail Making Test, UPDRS = United Parkinson's disease Rating Scale, deep brain stimulation, fMRI = functional MRI, neuropsychology, subthalamic nucleus.
Abstract
The aim of this study was to examine possible neuropsychological changes in patients with advanced idiopathic Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients (age = 67 ± 8 years, years with Parkinson's disease = 15 ± 3, verbal IQ = 114 ± 12) were evaluated (in their best `on state') with tests assessing processes reliant on the functional integrity of frontal striatal circuitry, prior to the procedure (n = 11), at 3–6 months (n = 11) and at 9–12 months (n =10) post-operatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3–6 months post-operative, significant declines were noted in working memory, speed of mental processing, bimanual motor speed and co-ordination, set switching, phonemic fluency, long-term consolidation of verbal material and the encoding of visuospatial material. Declines were more consistently observed in patients who were older than 69 years, leading to a mental state comparable with progressive supranuclear palsy. `Frontal' behavioural dyscontrol without the benefit of insight was also reported by half (three of six) of the caregivers of the elderly subgroup. At 9–12 months postoperative, only learning based on multiple trials had recovered. Tasks reliant on the integrity of frontal striatal circuitry either did not recover or gradually worsened over time. Bilateral STN DBS can have a negative impact on various aspects of frontal executive functioning, especially in patients older than 69 years. Future studies will evaluate a larger group of patients and examine the possible reversibility of these effects by turning the DBS off.
Url:
DOI: 10.1093/brain/123.10.2091
Links to Exploration step
ISTEX:81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10FLe document en format XML
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Tre Panier</name><affiliation><mods:affiliation>Departments of Medicine, Division of Neurology and</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Psychology, York University, Toronto, Canada and</mods:affiliation></affiliation></author><author><name sortKey="Kumar, Rajeev" sort="Kumar, Rajeev" uniqKey="Kumar R" first="Rajeev" last="Kumar">Rajeev Kumar</name><affiliation><mods:affiliation>Colorado Neurological Institute, Englewood, Colorado, USA</mods:affiliation></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation><mods:affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. 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Saint-Cyr</name><affiliation><mods:affiliation>Departments of Medicine, Division of Neurology and</mods:affiliation></affiliation><affiliation><mods:affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Psychology, University of Toronto,</mods:affiliation></affiliation></author><author><name sortKey="Tre Panier, Lisa L" sort="Tre Panier, Lisa L" uniqKey="Tre Panier L" first="Lisa L." last="Tre Panier">Lisa L. Tre Panier</name><affiliation><mods:affiliation>Departments of Medicine, Division of Neurology and</mods:affiliation></affiliation><affiliation><mods:affiliation>Department of Psychology, York University, Toronto, Canada and</mods:affiliation></affiliation></author><author><name sortKey="Kumar, Rajeev" sort="Kumar, Rajeev" uniqKey="Kumar R" first="Rajeev" last="Kumar">Rajeev Kumar</name><affiliation><mods:affiliation>Colorado Neurological Institute, Englewood, Colorado, USA</mods:affiliation></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation><mods:affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</mods:affiliation></affiliation></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A. E." last="Lang">A. E. Lang</name><affiliation><mods:affiliation>Departments of Medicine, Division of Neurology and</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2000-10">2000-10</date><biblScope unit="volume">123</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="2091">2091</biblScope><biblScope unit="page" to="2108">2108</biblScope></imprint><idno type="ISSN">0006-8950</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>ADL = activities of daily living</term><term>BEM = Batterie d'efficience mnésique</term><term>CALT = Conditional Associative Learning Test</term><term>CVLT = California Verbal Learning Test</term><term>DBS = deep brain stimulation</term><term>FLOPS = Frontal Lobe Personality Scale</term><term>GDI = Geriatric Depression Inventory</term><term>GPi = globus pallidus, internal segment</term><term>PASAT = Paced Auditory Serial Addition Test</term><term>PSP = Progressive Supranuclear Palsy</term><term>PVP = posteroventral pallidotomy</term><term>Parkinson's disease</term><term>SMA = supplementary motor area</term><term>STN = subthalamic nucleus</term><term>TMT = Trail Making Test</term><term>UPDRS = United Parkinson's disease Rating Scale</term><term>deep brain stimulation</term><term>fMRI = functional MRI</term><term>neuropsychology</term><term>subthalamic nucleus</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The aim of this study was to examine possible neuropsychological changes in patients with advanced idiopathic Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients (age = 67 ± 8 years, years with Parkinson's disease = 15 ± 3, verbal IQ = 114 ± 12) were evaluated (in their best `on state') with tests assessing processes reliant on the functional integrity of frontal striatal circuitry, prior to the procedure (n = 11), at 3–6 months (n = 11) and at 9–12 months (n =10) post-operatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3–6 months post-operative, significant declines were noted in working memory, speed of mental processing, bimanual motor speed and co-ordination, set switching, phonemic fluency, long-term consolidation of verbal material and the encoding of visuospatial material. Declines were more consistently observed in patients who were older than 69 years, leading to a mental state comparable with progressive supranuclear palsy. `Frontal' behavioural dyscontrol without the benefit of insight was also reported by half (three of six) of the caregivers of the elderly subgroup. At 9–12 months postoperative, only learning based on multiple trials had recovered. Tasks reliant on the integrity of frontal striatal circuitry either did not recover or gradually worsened over time. Bilateral STN DBS can have a negative impact on various aspects of frontal executive functioning, especially in patients older than 69 years. Future studies will evaluate a larger group of patients and examine the possible reversibility of these effects by turning the DBS off.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Jean A. Saint-Cyr</name><affiliations><json:string>Departments of Medicine, Division of Neurology and</json:string><json:string>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</json:string><json:string>Department of Psychology, University of Toronto,</json:string></affiliations></json:item><json:item><name>Lisa L. Trépanier</name><affiliations><json:string>Departments of Medicine, Division of Neurology and</json:string><json:string>Department of Psychology, York University, Toronto, Canada and</json:string></affiliations></json:item><json:item><name>Rajeev Kumar</name><affiliations><json:string>Colorado Neurological Institute, Englewood, Colorado, USA</json:string></affiliations></json:item><json:item><name>Andres M. Lozano</name><affiliations><json:string>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</json:string></affiliations></json:item><json:item><name>A. E. Lang</name><affiliations><json:string>Departments of Medicine, Division of Neurology and</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>neuropsychology</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>ADL = activities of daily living</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>BEM = Batterie d'efficience mnésique</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>CALT = Conditional Associative Learning Test</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>CVLT = California Verbal Learning Test</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>DBS = deep brain stimulation</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>FLOPS = Frontal Lobe Personality Scale</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>fMRI = functional MRI</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GDI = Geriatric Depression Inventory</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>GPi = globus pallidus, internal segment</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PASAT = Paced Auditory Serial Addition Test</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PSP = Progressive Supranuclear Palsy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>PVP = posteroventral pallidotomy</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>SMA = supplementary motor area</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>STN = subthalamic nucleus</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>TMT = Trail Making Test</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>UPDRS = United Parkinson's disease Rating Scale</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>The aim of this study was to examine possible neuropsychological changes in patients with advanced idiopathic Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients (age = 67 ± 8 years, years with Parkinson's disease = 15 ± 3, verbal IQ = 114 ± 12) were evaluated (in their best `on state') with tests assessing processes reliant on the functional integrity of frontal striatal circuitry, prior to the procedure (n = 11), at 3–6 months (n = 11) and at 9–12 months (n =10) post-operatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3–6 months post-operative, significant declines were noted in working memory, speed of mental processing, bimanual motor speed and co-ordination, set switching, phonemic fluency, long-term consolidation of verbal material and the encoding of visuospatial material. Declines were more consistently observed in patients who were older than 69 years, leading to a mental state comparable with progressive supranuclear palsy. `Frontal' behavioural dyscontrol without the benefit of insight was also reported by half (three of six) of the caregivers of the elderly subgroup. At 9–12 months postoperative, only learning based on multiple trials had recovered. Tasks reliant on the integrity of frontal striatal circuitry either did not recover or gradually worsened over time. Bilateral STN DBS can have a negative impact on various aspects of frontal executive functioning, especially in patients older than 69 years. Future studies will evaluate a larger group of patients and examine the possible reversibility of these effects by turning the DBS off.</abstract><qualityIndicators><score>10</score><pdfWordCount>10687</pdfWordCount><pdfCharCount>71834</pdfCharCount><pdfVersion>1.2</pdfVersion><pdfPageCount>18</pdfPageCount><pdfPageSize>612 x 791 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>260</abstractWordCount><abstractCharCount>1688</abstractCharCount><keywordCount>20</keywordCount></qualityIndicators><title>Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</title><pii><json:string>1460-2156</json:string></pii><genre><json:string>research-article</json:string></genre><host><title>Brain</title><language><json:string>unknown</json:string></language><issn><json:string>0006-8950</json:string></issn><eissn><json:string>1460-2156</json:string></eissn><publisherId><json:string>brainj</json:string></publisherId><volume>123</volume><issue>10</issue><pages><first>2091</first><last>2108</last></pages><genre><json:string>journal</json:string></genre></host><categories><wos><json:string>science</json:string><json:string>neurosciences</json:string><json:string>clinical neurology</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>neurology & neurosurgery</json:string></scienceMetrix><inist><json:string>sciences appliquees, technologies et medecines</json:string><json:string>sciences biologiques et medicales</json:string><json:string>sciences medicales</json:string></inist></categories><publicationDate>2000</publicationDate><copyrightDate>2000</copyrightDate><doi><json:string>10.1093/brain/123.10.2091</json:string></doi><id>81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F</id><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api-v5.istex.fr/document/81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api-v5.istex.fr/document/81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api-v5.istex.fr/document/81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>© Oxford University Press 2000</p></availability><date>2000</date></publicationStmt><notesStmt><note>Dr Jean Saint-Cyr, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Centre for Movement Disorders, Main Pavillion, 11-304, Toronto, Ontario, Canada M5T 2S8 E-mail: jean@playfair.utoronto.ca</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</title><author xml:id="author-0000"><persName><forename type="first">Jean A.</forename><surname>Saint-Cyr</surname></persName><affiliation>Departments of Medicine, Division of Neurology and</affiliation><affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</affiliation><affiliation>Department of Psychology, University of Toronto,</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Lisa L.</forename><surname>Trépanier</surname></persName><affiliation>Departments of Medicine, Division of Neurology and</affiliation><affiliation>Department of Psychology, York University, Toronto, Canada and</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Rajeev</forename><surname>Kumar</surname></persName><affiliation>Colorado Neurological Institute, Englewood, Colorado, USA</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Andres M.</forename><surname>Lozano</surname></persName><affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</affiliation></author><author xml:id="author-0004"><persName><forename type="first">A. E.</forename><surname>Lang</surname></persName><affiliation>Departments of Medicine, Division of Neurology and</affiliation></author><idno type="istex">81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F</idno><idno type="DOI">10.1093/brain/123.10.2091</idno><idno type="PII">1460-2156</idno><idno type="local">1232091</idno></analytic><monogr><title level="j">Brain</title><title level="j" type="abbrev">Brain</title><idno type="pISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><idno type="PublisherID">brainj</idno><idno type="PublisherID-hwp">brain</idno><idno type="PublisherID-nlm-ta">Brain</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2000-10"></date><biblScope unit="volume">123</biblScope><biblScope unit="issue">10</biblScope><biblScope unit="page" from="2091">2091</biblScope><biblScope unit="page" to="2108">2108</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2000</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The aim of this study was to examine possible neuropsychological changes in patients with advanced idiopathic Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients (age = 67 ± 8 years, years with Parkinson's disease = 15 ± 3, verbal IQ = 114 ± 12) were evaluated (in their best `on state') with tests assessing processes reliant on the functional integrity of frontal striatal circuitry, prior to the procedure (n = 11), at 3–6 months (n = 11) and at 9–12 months (n =10) post-operatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3–6 months post-operative, significant declines were noted in working memory, speed of mental processing, bimanual motor speed and co-ordination, set switching, phonemic fluency, long-term consolidation of verbal material and the encoding of visuospatial material. Declines were more consistently observed in patients who were older than 69 years, leading to a mental state comparable with progressive supranuclear palsy. `Frontal' behavioural dyscontrol without the benefit of insight was also reported by half (three of six) of the caregivers of the elderly subgroup. At 9–12 months postoperative, only learning based on multiple trials had recovered. Tasks reliant on the integrity of frontal striatal circuitry either did not recover or gradually worsened over time. Bilateral STN DBS can have a negative impact on various aspects of frontal executive functioning, especially in patients older than 69 years. Future studies will evaluate a larger group of patients and examine the possible reversibility of these effects by turning the DBS off.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>neuropsychology</term></item><item><term>subthalamic nucleus</term></item><item><term>deep brain stimulation</term></item><item><term>Parkinson's disease</term></item></list></keywords></textClass><textClass xml:lang="en"><keywords scheme="keyword"><list><head>ABR</head><item><term>ADL = activities of daily living</term></item><item><term>BEM = Batterie d'efficience mnésique</term></item><item><term>CALT = Conditional Associative Learning Test</term></item><item><term>CVLT = California Verbal Learning Test</term></item><item><term>DBS = deep brain stimulation</term></item><item><term>FLOPS = Frontal Lobe Personality Scale</term></item><item><term>fMRI = functional MRI</term></item><item><term>GDI = Geriatric Depression Inventory</term></item><item><term>GPi = globus pallidus, internal segment</term></item><item><term>PASAT = Paced Auditory Serial Addition Test</term></item><item><term>PSP = Progressive Supranuclear Palsy</term></item><item><term>PVP = posteroventral pallidotomy</term></item><item><term>SMA = supplementary motor area</term></item><item><term>STN = subthalamic nucleus</term></item><item><term>TMT = Trail Making Test</term></item><item><term>UPDRS = United Parkinson's disease Rating Scale</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2000-10">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api-v5.istex.fr/document/81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">brain</journal-id><journal-id journal-id-type="nlm-ta">Brain</journal-id><journal-id journal-id-type="publisher-id">brainj</journal-id><journal-title>Brain</journal-title><abbrev-journal-title abbrev-type="publisher">Brain</abbrev-journal-title><issn pub-type="ppub">0006-8950</issn><issn pub-type="epub">1460-2156</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">1232091</article-id><article-id pub-id-type="doi">10.1093/brain/123.10.2091</article-id><article-id pub-id-type="pii">1460-2156</article-id><title-group><article-title>Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Saint-Cyr</surname><given-names>Jean A.</given-names></name><xref rid="AFF1">1</xref><xref rid="AFF2">2</xref><xref rid="AFF3">3</xref></contrib><contrib contrib-type="author"><name><surname>Trépanier</surname><given-names>Lisa L.</given-names></name><xref rid="AFF1">1</xref><xref rid="AFF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Kumar</surname><given-names>Rajeev</given-names></name><xref rid="AFF5">5</xref></contrib><contrib contrib-type="author"><name><surname>Lozano</surname><given-names>Andres M.</given-names></name><xref rid="AFF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Lang</surname><given-names>A. E.</given-names></name><xref rid="AFF1">1</xref></contrib><aff id="AFF1"><label>1</label>Departments of Medicine, Division of Neurology and </aff><aff id="AFF2"><label>2</label>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital, </aff><aff id="AFF3"><label>3</label>Department of Psychology, University of Toronto, </aff><aff id="AFF4"><label>4</label>Department of Psychology, York University, Toronto, Canada and </aff><aff id="AFF5"><label>5</label>Colorado Neurological Institute, Englewood, Colorado, USA</aff></contrib-group><author-notes><corresp>Dr Jean Saint-Cyr, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Centre for Movement Disorders, Main Pavillion, 11-304, Toronto, Ontario, Canada M5T 2S8 E-mail: <ext-link xlink:href="jean@playfair.utoronto.ca" ext-link-type="email">jean@playfair.utoronto.ca</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>10</month><year>2000</year></pub-date><volume>123</volume><issue>10</issue><fpage>2091</fpage><lpage>2108</lpage><history><date date-type="accepted"><day>05</day><month>06</month><year>2000</year></date><date date-type="received"><day>18</day><month>02</month><year>2000</year></date><date date-type="rev-recd"><day>08</day><month>05</month><year>2000</year></date></history><copyright-statement>© Oxford University Press 2000</copyright-statement><copyright-year>2000</copyright-year><abstract xml:lang="en"><p>The aim of this study was to examine possible neuropsychological changes in patients with advanced idiopathic Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients (age = 67 ± 8 years, years with Parkinson's disease = 15 ± 3, verbal IQ = 114 ± 12) were evaluated (in their best `on state') with tests assessing processes reliant on the functional integrity of frontal striatal circuitry, prior to the procedure (<italic>n</italic> = 11), at 3–6 months (<italic>n</italic> = 11) and at 9–12 months (<italic>n</italic> =10) post-operatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3–6 months post-operative, significant declines were noted in working memory, speed of mental processing, bimanual motor speed and co-ordination, set switching, phonemic fluency, long-term consolidation of verbal material and the encoding of visuospatial material. Declines were more consistently observed in patients who were older than 69 years, leading to a mental state comparable with progressive supranuclear palsy. `Frontal' behavioural dyscontrol without the benefit of insight was also reported by half (three of six) of the caregivers of the elderly subgroup. At 9–12 months postoperative, only learning based on multiple trials had recovered. Tasks reliant on the integrity of frontal striatal circuitry either did not recover or gradually worsened over time. Bilateral STN DBS can have a negative impact on various aspects of frontal executive functioning, especially in patients older than 69 years. Future studies will evaluate a larger group of patients and examine the possible reversibility of these effects by turning the DBS off.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>neuropsychology</kwd><kwd>subthalamic nucleus</kwd><kwd>deep brain stimulation</kwd><kwd>Parkinson's disease</kwd></kwd-group><kwd-group kwd-group-type="ABR" xml:lang="en"><kwd>ADL = activities of daily living</kwd><kwd>BEM = Batterie d'efficience mnésique</kwd><kwd>CALT = Conditional Associative Learning Test</kwd><kwd>CVLT = California Verbal Learning Test</kwd><kwd>DBS = deep brain stimulation</kwd><kwd>FLOPS = Frontal Lobe Personality Scale</kwd><kwd>fMRI = functional MRI</kwd><kwd>GDI = Geriatric Depression Inventory</kwd><kwd>GPi = globus pallidus, internal segment</kwd><kwd>PASAT = Paced Auditory Serial Addition Test</kwd><kwd>PSP = Progressive Supranuclear Palsy</kwd><kwd>PVP = posteroventral pallidotomy</kwd><kwd>SMA = supplementary motor area</kwd><kwd>STN = subthalamic nucleus</kwd><kwd>TMT = Trail Making Test</kwd><kwd>UPDRS = United Parkinson's disease Rating Scale</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>2091</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Article</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</title></titleInfo><name type="personal"><namePart type="given">Jean A.</namePart><namePart type="family">Saint-Cyr</namePart><affiliation>Departments of Medicine, Division of Neurology and</affiliation><affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</affiliation><affiliation>Department of Psychology, University of Toronto,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lisa L.</namePart><namePart type="family">Trépanier</namePart><affiliation>Departments of Medicine, Division of Neurology and</affiliation><affiliation>Department of Psychology, York University, Toronto, Canada and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rajeev</namePart><namePart type="family">Kumar</namePart><affiliation>Colorado Neurological Institute, Englewood, Colorado, USA</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Andres M.</namePart><namePart type="family">Lozano</namePart><affiliation>Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital,</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A. E.</namePart><namePart type="family">Lang</namePart><affiliation>Departments of Medicine, Division of Neurology and</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2000-10</dateIssued><copyrightDate encoding="w3cdtf">2000</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The aim of this study was to examine possible neuropsychological changes in patients with advanced idiopathic Parkinson's disease treated with bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Eleven patients (age = 67 ± 8 years, years with Parkinson's disease = 15 ± 3, verbal IQ = 114 ± 12) were evaluated (in their best `on state') with tests assessing processes reliant on the functional integrity of frontal striatal circuitry, prior to the procedure (n = 11), at 3–6 months (n = 11) and at 9–12 months (n =10) post-operatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3–6 months post-operative, significant declines were noted in working memory, speed of mental processing, bimanual motor speed and co-ordination, set switching, phonemic fluency, long-term consolidation of verbal material and the encoding of visuospatial material. Declines were more consistently observed in patients who were older than 69 years, leading to a mental state comparable with progressive supranuclear palsy. `Frontal' behavioural dyscontrol without the benefit of insight was also reported by half (three of six) of the caregivers of the elderly subgroup. At 9–12 months postoperative, only learning based on multiple trials had recovered. Tasks reliant on the integrity of frontal striatal circuitry either did not recover or gradually worsened over time. Bilateral STN DBS can have a negative impact on various aspects of frontal executive functioning, especially in patients older than 69 years. Future studies will evaluate a larger group of patients and examine the possible reversibility of these effects by turning the DBS off.</abstract><note type="author-notes">Dr Jean Saint-Cyr, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Centre for Movement Disorders, Main Pavillion, 11-304, Toronto, Ontario, Canada M5T 2S8 E-mail: jean@playfair.utoronto.ca</note><subject lang="en"><genre>KWD</genre><topic>neuropsychology</topic><topic>subthalamic nucleus</topic><topic>deep brain stimulation</topic><topic>Parkinson's disease</topic></subject><subject lang="en"><genre>ABR</genre><topic>ADL = activities of daily living</topic><topic>BEM = Batterie d'efficience mnésique</topic><topic>CALT = Conditional Associative Learning Test</topic><topic>CVLT = California Verbal Learning Test</topic><topic>DBS = deep brain stimulation</topic><topic>FLOPS = Frontal Lobe Personality Scale</topic><topic>fMRI = functional MRI</topic><topic>GDI = Geriatric Depression Inventory</topic><topic>GPi = globus pallidus, internal segment</topic><topic>PASAT = Paced Auditory Serial Addition Test</topic><topic>PSP = Progressive Supranuclear Palsy</topic><topic>PVP = posteroventral pallidotomy</topic><topic>SMA = supplementary motor area</topic><topic>STN = subthalamic nucleus</topic><topic>TMT = Trail Making Test</topic><topic>UPDRS = United Parkinson's disease Rating Scale</topic></subject><relatedItem type="host"><titleInfo><title>Brain</title></titleInfo><titleInfo type="abbreviated"><title>Brain</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0006-8950</identifier><identifier type="eISSN">1460-2156</identifier><identifier type="PublisherID">brainj</identifier><identifier type="PublisherID-hwp">brain</identifier><identifier type="PublisherID-nlm-ta">Brain</identifier><part><date>2000</date><detail type="volume"><caption>vol.</caption><number>123</number></detail><detail type="issue"><caption>no.</caption><number>10</number></detail><extent unit="pages"><start>2091</start><end>2108</end></extent></part></relatedItem><identifier type="istex">81ABC1A2B70D48CD9FB33886343A9A2C0ADBA10F</identifier><identifier type="DOI">10.1093/brain/123.10.2091</identifier><identifier type="PII">1460-2156</identifier><identifier type="local">1232091</identifier><accessCondition type="use and reproduction" contentType="copyright">© Oxford University Press 2000</accessCondition><recordInfo><recordContentSource>OUP</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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