Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease
Identifieur interne : 000056 ( PascalFrancis/Curation ); précédent : 000055; suivant : 000057Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease
Auteurs : Jean A. Saint-Cyr [Canada] ; Lisa L. Trepanier [Canada] ; Rajeev Kumar [États-Unis] ; Andres M. Lozano [Canada] ; A. E. Lang [Canada]Source :
- Brain [ 0006-8950 ] ; 2000.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
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) postoperatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3-6 months postoperative, 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.
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Saint-Cyr</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Psychology, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Trepanier, Lisa L" sort="Trepanier, Lisa L" uniqKey="Trepanier L" first="Lisa L." last="Trepanier">Lisa L. 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Lozano</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Canada</country></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 wicri:level="1"><inist:fA14 i1="01"><s1>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Psychology, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Trepanier, Lisa L" sort="Trepanier, Lisa L" uniqKey="Trepanier L" first="Lisa L." last="Trepanier">Lisa L. Trepanier</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Department of Psychology, York University</s1><s2>Toronto</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="Kumar, Rajeev" sort="Kumar, Rajeev" uniqKey="Kumar R" first="Rajeev" last="Kumar">Rajeev Kumar</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Colorado Neurological Institute</s1><s2>Englewood, Colorado</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country></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 wicri:level="1"><inist:fA14 i1="02"><s1>Department of Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></inist:fA14><country>Canada</country></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 wicri:level="1"><inist:fA14 i1="01"><s1>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author></analytic><series><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno><imprint><date when="2000">2000</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Bilateral</term><term>Chronic</term><term>Exploration</term><term>Human</term><term>Instrumental stimulation</term><term>Neuropsychological test</term><term>Parkinson disease</term><term>Psychometrics</term><term>Subthalamic nucleus</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Parkinson maladie</term><term>Stimulation instrumentale</term><term>Bilatéral</term><term>Chronique</term><term>Noyau sousthalamique</term><term>Test neuropsychologique</term><term>Psychométrie</term><term>Exploration</term><term>Homme</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</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) postoperatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3-6 months postoperative, 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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0006-8950</s0></fA01><fA03 i2="1"><s0>Brain</s0></fA03><fA05><s2>123</s2></fA05><fA06><s3>p.10</s3></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson's disease</s1></fA08><fA11 i1="01" i2="1"><s1>SAINT-CYR (Jean A.)</s1></fA11><fA11 i1="02" i2="1"><s1>TREPANIER (Lisa L.)</s1></fA11><fA11 i1="03" i2="1"><s1>KUMAR (Rajeev)</s1></fA11><fA11 i1="04" i2="1"><s1>LOZANO (Andres M.)</s1></fA11><fA11 i1="05" i2="1"><s1>LANG (A. E.)</s1></fA11><fA14 i1="01"><s1>Department of Medicine, Division of Neurology, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>5 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Surgery, Division of Neurosurgery, University Health Network, Toronto Western Hospital Research Institute, University of Toronto and The Toronto Western Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Psychology, University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ></fA14><fA14 i1="04"><s1>Department of Psychology, York University</s1><s2>Toronto</s2><s3>CAN</s3><sZ>2 aut.</sZ></fA14><fA14 i1="05"><s1>Colorado Neurological Institute</s1><s2>Englewood, Colorado</s2><s3>USA</s3><sZ>3 aut.</sZ></fA14><fA20><s1>2091-2108</s1></fA20><fA21><s1>2000</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>998</s2><s5>354000092209490110</s5></fA43><fA44><s0>0000</s0><s1>© 2000 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>3 p.1/4</s0></fA45><fA47 i1="01" i2="1"><s0>00-0486498</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Brain</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>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) postoperatively. Six of these patients were older than 69 years. Despite clinical motor benefits at 3-6 months postoperative, 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. 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