Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease.
Identifieur interne : 000122 ( Ncbi/Curation ); précédent : 000121; suivant : 000123Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease.
Auteurs : J A Saint-Cyr [Canada] ; L L Trépanier ; R. Kumar ; A M Lozano ; A E LangSource :
- Brain : a journal of neurology [ 0006-8950 ] ; 2000.
English descriptors
- KwdEn :
- Affect, Age Factors, Aged, Attention, Cognition Disorders (diagnosis), Cognition Disorders (etiology), Electric Stimulation Therapy (adverse effects), Female, Fingers (physiology), Follow-Up Studies, Frontal Lobe (physiology), Humans, Male, Memory, Middle Aged, Motor Activity, Neuropsychological Tests, Parkinson Disease (physiopathology), Parkinson Disease (psychology), Parkinson Disease (therapy), Personality, Photic Stimulation, Postoperative Complications (physiopathology), Postoperative Complications (psychology), Speech, Subthalamic Nucleus (physiology), Verbal Learning.
- MESH :
- adverse effects : Electric Stimulation Therapy.
- diagnosis : Cognition Disorders.
- etiology : Cognition Disorders.
- physiology : Fingers, Frontal Lobe, Subthalamic Nucleus.
- physiopathology : Parkinson Disease, Postoperative Complications.
- psychology : Parkinson Disease, Postoperative Complications.
- therapy : Parkinson Disease.
- Affect, Age Factors, Aged, Attention, Female, Follow-Up Studies, Humans, Male, Memory, Middle Aged, Motor Activity, Neuropsychological Tests, Personality, Photic Stimulation, Speech, Verbal Learning.
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.
PubMed: 11004126
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Kumar</name></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A M" last="Lozano">A M Lozano</name></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A E" last="Lang">A E Lang</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2000">2000</date><idno type="RBID">pubmed:11004126</idno><idno type="pmid">11004126</idno><idno type="wicri:Area/PubMed/Corpus">001613</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001613</idno><idno type="wicri:Area/PubMed/Curation">001613</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">001613</idno><idno type="wicri:Area/PubMed/Checkpoint">001613</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">001613</idno><idno type="wicri:Area/Ncbi/Merge">000122</idno><idno type="wicri:Area/Ncbi/Curation">000122</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease.</title><author><name sortKey="Saint Cyr, J A" sort="Saint Cyr, J A" uniqKey="Saint Cyr J" first="J A" last="Saint-Cyr">J A Saint-Cyr</name><affiliation wicri:level="1"><nlm:affiliation>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital, Ontario, Canada. jean@playfair.utoronto.ca</nlm:affiliation><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Trepanier, L L" sort="Trepanier, L L" uniqKey="Trepanier L" first="L L" last="Trépanier">L L Trépanier</name></author><author><name sortKey="Kumar, R" sort="Kumar, R" uniqKey="Kumar R" first="R" last="Kumar">R. Kumar</name></author><author><name sortKey="Lozano, A M" sort="Lozano, A M" uniqKey="Lozano A" first="A M" last="Lozano">A M Lozano</name></author><author><name sortKey="Lang, A E" sort="Lang, A E" uniqKey="Lang A" first="A E" last="Lang">A E Lang</name></author></analytic><series><title level="j">Brain : a journal of neurology</title><idno type="ISSN">0006-8950</idno><imprint><date when="2000" type="published">2000</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Affect</term><term>Age Factors</term><term>Aged</term><term>Attention</term><term>Cognition Disorders (diagnosis)</term><term>Cognition Disorders (etiology)</term><term>Electric Stimulation Therapy (adverse effects)</term><term>Female</term><term>Fingers (physiology)</term><term>Follow-Up Studies</term><term>Frontal Lobe (physiology)</term><term>Humans</term><term>Male</term><term>Memory</term><term>Middle Aged</term><term>Motor Activity</term><term>Neuropsychological Tests</term><term>Parkinson Disease (physiopathology)</term><term>Parkinson Disease (psychology)</term><term>Parkinson Disease (therapy)</term><term>Personality</term><term>Photic Stimulation</term><term>Postoperative Complications (physiopathology)</term><term>Postoperative Complications (psychology)</term><term>Speech</term><term>Subthalamic Nucleus (physiology)</term><term>Verbal Learning</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Electric Stimulation Therapy</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Cognition Disorders</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Cognition Disorders</term></keywords><keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Fingers</term><term>Frontal Lobe</term><term>Subthalamic Nucleus</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Parkinson Disease</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Parkinson Disease</term><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Affect</term><term>Age Factors</term><term>Aged</term><term>Attention</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Male</term><term>Memory</term><term>Middle Aged</term><term>Motor Activity</term><term>Neuropsychological Tests</term><term>Personality</term><term>Photic Stimulation</term><term>Speech</term><term>Verbal Learning</term></keywords></textClass></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></record>Pour manipuler ce document sous Unix (Dilib)
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