Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease.
Identifieur interne : 000023 ( Hal/Checkpoint ); précédent : 000022; suivant : 000024Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease.
Auteurs : Christine Daniels [Allemagne] ; Paul Krack [Allemagne] ; Jens Volkmann [Allemagne] ; Markus O. Pinsker [Allemagne] ; Martin Krause [Allemagne] ; Volker Tronnier [Allemagne] ; Manja Kloss [Allemagne] ; Alfons Schnitzler [Allemagne] ; Lars Wojtecki [Allemagne] ; Kai Bötzel [Allemagne] ; Adrian Danek [Allemagne] ; Rüdiger Hilker [Allemagne] ; Volker Sturm [Allemagne] ; Andreas Kupsch [Allemagne] ; Elfriede Karner [Autriche] ; Günther Deuschl [Allemagne] ; Karsten Witt [Allemagne]Source :
- Movement Disorders [ 0885-3185 ] ; 2010-08-15.
Abstract
A slight decline in cognitive functions and especially in executive functioning after deep brain stimulation (DBS) of the nucleus subthalamicus (STN) in patients with Parkinson's disease (PD) has been described. This study evaluated baseline parameters that contribute to a deterioration of cognitive functioning after DBS. We analyzed data from the neuropsychological protocol in a randomized controlled study comparing DBS with best medical treatment (BMT). Change scores were calculated for the cognitive domains "global cognitive functioning," "memory," "working memory," "attention," and "executive function." These domain-specific change scores were correlated with previously defined preoperative parameters. Compared with the BMT group (63 patients), the STN-DBS group (60 patients) showed a significant decline only in the domain executive function 6 months after DBS, which was significantly correlated with age, levodopa-equivalence dosage (LED) and axial subscore of the UPDRS in the off-medication state at baseline. Multiple regression analysis showed that these three factors explained, however, only about 23% of the variance. Patients with higher age, higher baseline LED, and/or higher axial subscore of the UPDRS at baseline have an increased risk for worsening of executive function after STN-DBS. High scores of these factors might reflect an advanced stage of disease progression. As these baseline factors explained the variance of the change score executive function only to a minor proportion, other factors including the surgical procedure, the exact placement of the electrode or postsurgical management might be more relevant for a decline in executive functioning after STN-DBS.
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DOI: 10.1002/mds.23078
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xml:lang="en">Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease.</title><author><name sortKey="Daniels, Christine" sort="Daniels, Christine" uniqKey="Daniels C" first="Christine" last="Daniels">Christine Daniels</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182743" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-302868" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-302868" type="direct"><org type="institution" xml:id="struct-302868" status="VALID"><orgName>Christian-Albrechts-Universität [Kiel]</orgName><orgName type="acronym">CAU</orgName><desc><address><addrLine>Christian-Albrechts-Platz 4 -24118 Kiel</addrLine><country key="DE"></country></address><ref type="url">http://www.uni-kiel.de</ref></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name><affiliation wicri:level="1"><hal:affiliation type="researchteam" xml:id="struct-399397" status="INCOMING"><orgName>ANTE-INSERM U836, équipe 10, Dynamique des réseaux neuronaux du mouvement</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-182743" type="direct"></relation><relation active="#struct-302868" type="indirect"></relation></listRelation><tutelles><tutelle active="#struct-182743" type="direct"><org type="laboratory" xml:id="struct-182743" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-302868" type="direct"></relation></listRelation></org></tutelle><tutelle active="#struct-302868" type="indirect"><org type="institution" xml:id="struct-302868" status="VALID"><orgName>Christian-Albrechts-Universität [Kiel]</orgName><orgName type="acronym">CAU</orgName><desc><address><addrLine>Christian-Albrechts-Platz 4 -24118 Kiel</addrLine><country key="DE"></country></address><ref type="url">http://www.uni-kiel.de</ref></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182743" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-302868" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-302868" 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key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182747" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-345712" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-345712" type="direct"><org type="institution" xml:id="struct-345712" status="INCOMING"><orgName>Heinrich Heine University, Dusseldorf</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Wojtecki, Lars" sort="Wojtecki, Lars" uniqKey="Wojtecki L" first="Lars" last="Wojtecki">Lars Wojtecki</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182747" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-345712" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-345712" type="direct"><org type="institution" xml:id="struct-345712" status="INCOMING"><orgName>Heinrich Heine University, Dusseldorf</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Botzel, Kai" sort="Botzel, Kai" uniqKey="Botzel K" first="Kai" last="Bötzel">Kai Bötzel</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182748" status="INCOMING"><orgName>Neurology department</orgName><desc><address><addrLine>Munich</addrLine><country 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key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Sturm, Volker" sort="Sturm, Volker" uniqKey="Sturm V" first="Volker" last="Sturm">Volker Sturm</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182750" status="INCOMING"><orgName>Department of Neurosurgery</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-321596" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-321596" type="direct"><org type="institution" xml:id="struct-321596" status="INCOMING"><orgName>Cologne University</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Kupsch, Andreas" sort="Kupsch, Andreas" uniqKey="Kupsch A" first="Andreas" last="Kupsch">Andreas Kupsch</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182751" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><addrLine>Charity Hospital - Berlin</addrLine><country key="DE"></country></address></desc><listRelation><relation active="#struct-139189" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-139189" type="direct"><org type="institution" xml:id="struct-139189" status="VALID"><orgName>Humboldt Universität zu Berlin [Berlin]</orgName><desc><address><addrLine>Unter den Linden 610099 Berlin</addrLine><country key="DE"></country></address><ref type="url">https://www.hu-berlin.de/en/</ref></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Karner, Elfriede" sort="Karner, Elfriede" uniqKey="Karner E" first="Elfriede" last="Karner">Elfriede Karner</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182752" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><addrLine>Innsbruck</addrLine><country key="AT"></country></address></desc><listRelation><relation active="#struct-314191" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-314191" type="direct"><org type="institution" xml:id="struct-314191" status="INCOMING"><orgName>Innsbruck Medical University</orgName><desc><address><country key="FR"></country></address></desc></org></tutelle></tutelles></hal:affiliation><country>Autriche</country></affiliation></author><author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182743" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-302868" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-302868" type="direct"><org type="institution" xml:id="struct-302868" status="VALID"><orgName>Christian-Albrechts-Universität [Kiel]</orgName><orgName type="acronym">CAU</orgName><desc><address><addrLine>Christian-Albrechts-Platz 4 -24118 Kiel</addrLine><country key="DE"></country></address><ref type="url">http://www.uni-kiel.de</ref></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author><author><name sortKey="Witt, Karsten" sort="Witt, Karsten" uniqKey="Witt K" first="Karsten" last="Witt">Karsten Witt</name><affiliation wicri:level="1"><hal:affiliation type="laboratory" xml:id="struct-182743" status="INCOMING"><orgName>Department of Neurology</orgName><desc><address><country key="DE"></country></address></desc><listRelation><relation active="#struct-302868" type="direct"></relation></listRelation><tutelles><tutelle active="#struct-302868" type="direct"><org type="institution" xml:id="struct-302868" status="VALID"><orgName>Christian-Albrechts-Universität [Kiel]</orgName><orgName type="acronym">CAU</orgName><desc><address><addrLine>Christian-Albrechts-Platz 4 -24118 Kiel</addrLine><country key="DE"></country></address><ref type="url">http://www.uni-kiel.de</ref></desc></org></tutelle></tutelles></hal:affiliation><country>Allemagne</country></affiliation></author></analytic><idno type="DOI">10.1002/mds.23078</idno><series><title level="j">Movement Disorders</title><idno type="ISSN">0885-3185</idno><imprint><date type="datePub">2010-08-15</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A slight decline in cognitive functions and especially in executive functioning after deep brain stimulation (DBS) of the nucleus subthalamicus (STN) in patients with Parkinson's disease (PD) has been described. This study evaluated baseline parameters that contribute to a deterioration of cognitive functioning after DBS. We analyzed data from the neuropsychological protocol in a randomized controlled study comparing DBS with best medical treatment (BMT). Change scores were calculated for the cognitive domains "global cognitive functioning," "memory," "working memory," "attention," and "executive function." These domain-specific change scores were correlated with previously defined preoperative parameters. Compared with the BMT group (63 patients), the STN-DBS group (60 patients) showed a significant decline only in the domain executive function 6 months after DBS, which was significantly correlated with age, levodopa-equivalence dosage (LED) and axial subscore of the UPDRS in the off-medication state at baseline. Multiple regression analysis showed that these three factors explained, however, only about 23% of the variance. Patients with higher age, higher baseline LED, and/or higher axial subscore of the UPDRS at baseline have an increased risk for worsening of executive function after STN-DBS. High scores of these factors might reflect an advanced stage of disease progression. As these baseline factors explained the variance of the change score executive function only to a minor proportion, other factors including the surgical procedure, the exact placement of the electrode or postsurgical management might be more relevant for a decline in executive functioning after STN-DBS.</div></front></TEI><hal api="V3"><titleStmt><title xml:lang="en">Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease.</title><author role="aut"><persName><forename type="first">Christine</forename><surname>Daniels</surname></persName><email></email><idno type="halauthor">410338</idno><affiliation ref="#struct-182743"></affiliation></author><author role="aut"><persName><forename type="first">Paul</forename><surname>Krack</surname></persName><email></email><idno type="halauthor">296412</idno><affiliation ref="#struct-399397"></affiliation></author><author role="aut"><persName><forename type="first">Jens</forename><surname>Volkmann</surname></persName><email></email><idno type="halauthor">410340</idno><affiliation ref="#struct-182743"></affiliation></author><author role="aut"><persName><forename type="first">Markus O</forename><surname>Pinsker</surname></persName><email></email><idno type="halauthor">688142</idno><affiliation ref="#struct-182744"></affiliation></author><author role="aut"><persName><forename type="first">Martin</forename><surname>Krause</surname></persName><email></email><idno type="halauthor">410342</idno><affiliation ref="#struct-182745"></affiliation></author><author role="aut"><persName><forename type="first">Volker</forename><surname>Tronnier</surname></persName><email></email><idno type="halauthor">410343</idno><affiliation ref="#struct-182746"></affiliation></author><author role="aut"><persName><forename type="first">Manja</forename><surname>Kloss</surname></persName><email></email><idno type="halauthor">410344</idno><affiliation ref="#struct-182745"></affiliation></author><author role="aut"><persName><forename type="first">Alfons</forename><surname>Schnitzler</surname></persName><email></email><idno type="halauthor">410345</idno><affiliation ref="#struct-182747"></affiliation></author><author role="aut"><persName><forename type="first">Lars</forename><surname>Wojtecki</surname></persName><email></email><idno type="halauthor">410346</idno><affiliation ref="#struct-182747"></affiliation></author><author role="aut"><persName><forename type="first">Kai</forename><surname>Bötzel</surname></persName><email></email><idno type="halauthor">410347</idno><affiliation ref="#struct-182748"></affiliation></author><author role="aut"><persName><forename type="first">Adrian</forename><surname>Danek</surname></persName><email></email><idno type="halauthor">410348</idno><affiliation ref="#struct-182748"></affiliation></author><author role="aut"><persName><forename type="first">Rüdiger</forename><surname>Hilker</surname></persName><email></email><idno type="halauthor">410349</idno><affiliation ref="#struct-182749"></affiliation></author><author role="aut"><persName><forename type="first">Volker</forename><surname>Sturm</surname></persName><email></email><idno type="halauthor">410350</idno><affiliation ref="#struct-182750"></affiliation></author><author role="aut"><persName><forename type="first">Andreas</forename><surname>Kupsch</surname></persName><email></email><idno type="halauthor">410351</idno><affiliation ref="#struct-182751"></affiliation></author><author role="aut"><persName><forename type="first">Elfriede</forename><surname>Karner</surname></persName><email></email><idno type="halauthor">410352</idno><affiliation ref="#struct-182752"></affiliation></author><author role="aut"><persName><forename type="first">Günther</forename><surname>Deuschl</surname></persName><email></email><idno type="halauthor">410353</idno><affiliation ref="#struct-182743"></affiliation></author><author role="crp"><persName><forename type="first">Karsten</forename><surname>Witt</surname></persName><email>k.witt@neurologie.uni-kiel.de</email><idno type="halauthor">688143</idno><affiliation ref="#struct-182743"></affiliation></author><editor role="depositor"><persName><forename>Marc</forename><surname>Savasta</surname></persName><email>marc.savasta@ujf-grenoble.fr</email></editor></titleStmt><editionStmt><edition n="v1" type="current"><date type="whenSubmitted">2012-02-03 15:54:48</date><date type="whenModified">2015-04-23 13:48:38</date><date type="whenReleased">2012-02-03 18:51:08</date><date type="whenProduced">2010-08-15</date><date type="whenEndEmbargoed">9999-12-31</date><ref type="file" target="http://www.hal.inserm.fr/inserm-00666166/document"><date notBefore="9999-12-31"></date></ref><ref type="file" subtype="greenPublisher" n="1" target="http://www.hal.inserm.fr/inserm-00666166/file/2010_Daniels_Risk_factor-VEditeur.PDF"><date notBefore="9999-12-31"></date></ref></edition><respStmt><resp>contributor</resp><name key="140382"><persName><forename>Marc</forename><surname>Savasta</surname></persName><email>marc.savasta@ujf-grenoble.fr</email></name></respStmt></editionStmt><publicationStmt><distributor>CCSD</distributor><idno type="halId">inserm-00666166</idno><idno type="halUri">http://www.hal.inserm.fr/inserm-00666166</idno><idno type="halBibtex">daniels:inserm-00666166</idno><idno type="halRefHtml">Movement Disorders, Wiley, 2010, 25 (11), pp.1583-9. <10.1002/mds.23078></idno><idno type="halRef">Movement Disorders, Wiley, 2010, 25 (11), pp.1583-9. <10.1002/mds.23078></idno></publicationStmt><seriesStmt><idno type="stamp" n="INSERM">INSERM - Institut national de la santé et de la recherche médicale</idno><idno type="stamp" n="U836" p="UGA">Grenoble Institut des Neurosciences</idno><idno type="stamp" n="UGA">HAL Grenoble Alpes</idno></seriesStmt><notesStmt><note type="audience" n="2">International</note><note type="popular" n="0">No</note><note type="peer" n="1">Yes</note></notesStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease.</title><author role="aut"><persName><forename type="first">Christine</forename><surname>Daniels</surname></persName><idno type="halAuthorId">410338</idno><affiliation ref="#struct-182743"></affiliation></author><author role="aut"><persName><forename type="first">Paul</forename><surname>Krack</surname></persName><idno type="halAuthorId">296412</idno><affiliation ref="#struct-399397"></affiliation></author><author role="aut"><persName><forename type="first">Jens</forename><surname>Volkmann</surname></persName><idno type="halAuthorId">410340</idno><affiliation ref="#struct-182743"></affiliation></author><author role="aut"><persName><forename type="first">Markus O</forename><surname>Pinsker</surname></persName><idno type="halAuthorId">688142</idno><affiliation ref="#struct-182744"></affiliation></author><author role="aut"><persName><forename type="first">Martin</forename><surname>Krause</surname></persName><idno type="halAuthorId">410342</idno><affiliation ref="#struct-182745"></affiliation></author><author role="aut"><persName><forename type="first">Volker</forename><surname>Tronnier</surname></persName><idno type="halAuthorId">410343</idno><affiliation ref="#struct-182746"></affiliation></author><author role="aut"><persName><forename type="first">Manja</forename><surname>Kloss</surname></persName><idno type="halAuthorId">410344</idno><affiliation ref="#struct-182745"></affiliation></author><author role="aut"><persName><forename type="first">Alfons</forename><surname>Schnitzler</surname></persName><idno type="halAuthorId">410345</idno><affiliation ref="#struct-182747"></affiliation></author><author role="aut"><persName><forename type="first">Lars</forename><surname>Wojtecki</surname></persName><idno type="halAuthorId">410346</idno><affiliation ref="#struct-182747"></affiliation></author><author role="aut"><persName><forename type="first">Kai</forename><surname>Bötzel</surname></persName><idno type="halAuthorId">410347</idno><affiliation ref="#struct-182748"></affiliation></author><author role="aut"><persName><forename type="first">Adrian</forename><surname>Danek</surname></persName><idno type="halAuthorId">410348</idno><affiliation ref="#struct-182748"></affiliation></author><author role="aut"><persName><forename type="first">Rüdiger</forename><surname>Hilker</surname></persName><idno type="halAuthorId">410349</idno><affiliation ref="#struct-182749"></affiliation></author><author role="aut"><persName><forename type="first">Volker</forename><surname>Sturm</surname></persName><idno type="halAuthorId">410350</idno><affiliation ref="#struct-182750"></affiliation></author><author role="aut"><persName><forename type="first">Andreas</forename><surname>Kupsch</surname></persName><idno type="halAuthorId">410351</idno><affiliation ref="#struct-182751"></affiliation></author><author role="aut"><persName><forename type="first">Elfriede</forename><surname>Karner</surname></persName><idno type="halAuthorId">410352</idno><affiliation ref="#struct-182752"></affiliation></author><author role="aut"><persName><forename type="first">Günther</forename><surname>Deuschl</surname></persName><idno type="halAuthorId">410353</idno><affiliation ref="#struct-182743"></affiliation></author><author role="crp"><persName><forename type="first">Karsten</forename><surname>Witt</surname></persName><email>k.witt@neurologie.uni-kiel.de</email><idno type="halAuthorId">688143</idno><affiliation ref="#struct-182743"></affiliation></author></analytic><monogr><idno type="halJournalId" status="VALID">17211</idno><idno type="issn">0885-3185</idno><idno type="eissn">1531-8257</idno><title level="j">Movement Disorders</title><imprint><publisher>Wiley</publisher><biblScope unit="volume">25</biblScope><biblScope unit="issue">11</biblScope><biblScope unit="pp">1583-9</biblScope><date type="datePub">2010-08-15</date></imprint></monogr><idno type="doi">10.1002/mds.23078</idno><idno type="pubmed">20589868</idno></biblStruct></sourceDesc><profileDesc><langUsage><language ident="en">English</language></langUsage><textClass><classCode scheme="mesh">Aged</classCode><classCode scheme="mesh">Cognition Disorders</classCode><classCode scheme="mesh">Parkinson Disease</classCode><classCode scheme="mesh">Risk Factors</classCode><classCode scheme="mesh">Statistics as Topic</classCode><classCode scheme="mesh">Subthalamic Nucleus</classCode><classCode scheme="mesh">Deep Brain Stimulation</classCode><classCode scheme="mesh">Executive Function</classCode><classCode scheme="mesh">Female</classCode><classCode scheme="mesh">Follow-Up Studies</classCode><classCode scheme="mesh">Humans</classCode><classCode scheme="mesh">Male</classCode><classCode scheme="mesh">Middle Aged</classCode><classCode scheme="mesh">Neuropsychological Tests</classCode><classCode scheme="halDomain" n="sdv.neu">Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]</classCode><classCode scheme="halTypology" n="ART">Journal articles</classCode></textClass><abstract xml:lang="en">A slight decline in cognitive functions and especially in executive functioning after deep brain stimulation (DBS) of the nucleus subthalamicus (STN) in patients with Parkinson's disease (PD) has been described. This study evaluated baseline parameters that contribute to a deterioration of cognitive functioning after DBS. We analyzed data from the neuropsychological protocol in a randomized controlled study comparing DBS with best medical treatment (BMT). Change scores were calculated for the cognitive domains "global cognitive functioning," "memory," "working memory," "attention," and "executive function." These domain-specific change scores were correlated with previously defined preoperative parameters. Compared with the BMT group (63 patients), the STN-DBS group (60 patients) showed a significant decline only in the domain executive function 6 months after DBS, which was significantly correlated with age, levodopa-equivalence dosage (LED) and axial subscore of the UPDRS in the off-medication state at baseline. Multiple regression analysis showed that these three factors explained, however, only about 23% of the variance. Patients with higher age, higher baseline LED, and/or higher axial subscore of the UPDRS at baseline have an increased risk for worsening of executive function after STN-DBS. High scores of these factors might reflect an advanced stage of disease progression. As these baseline factors explained the variance of the change score executive function only to a minor proportion, other factors including the surgical procedure, the exact placement of the electrode or postsurgical management might be more relevant for a decline in executive functioning after STN-DBS.</abstract></profileDesc></hal></record>Pour manipuler ce document sous Unix (Dilib)
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