Risk Factors for Executive Dysfunction After Subthalamic Nucleus Stimulation in Parkinson's Disease
Identifieur interne : 002441 ( Main/Merge ); précédent : 002440; suivant : 002442Risk 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.
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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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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">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="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian-Albrechts-University</s1>
<s2>Kiel</s2>
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</placeName>
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<author><name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name>
<affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian-Albrechts-University</s1>
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<author><name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name>
<affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian-Albrechts-University</s1>
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<author><name sortKey="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O." last="Pinsker">Markus O. Pinsker</name>
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<author><name sortKey="Kloss, Manja" sort="Kloss, Manja" uniqKey="Kloss M" first="Manja" last="Kloss">Manja Kloss</name>
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<author><name sortKey="Botzel, Kai" sort="Botzel, Kai" uniqKey="Botzel K" first="Kai" last="Bötzel">Kai Bötzel</name>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Department of Neurology, Ludwig-Maximilians-University</s1>
<s2>Munich</s2>
<s3>DEU</s3>
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<author><name sortKey="Danek, Adrian" sort="Danek, Adrian" uniqKey="Danek A" first="Adrian" last="Danek">Adrian Danek</name>
<affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Department of Neurology, Ludwig-Maximilians-University</s1>
<s2>Munich</s2>
<s3>DEU</s3>
<sZ>10 aut.</sZ>
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<region type="district" nuts="2">District de Haute-Bavière</region>
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<author><name sortKey="Hilker, Rudiger" sort="Hilker, Rudiger" uniqKey="Hilker R" first="Rüdiger" last="Hilker">Rüdiger Hilker</name>
<affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Neurology, Cologne University</s1>
<s2>Cologne</s2>
<s3>DEU</s3>
<sZ>12 aut.</sZ>
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</affiliation>
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<author><name sortKey="Sturm, Volker" sort="Sturm, Volker" uniqKey="Sturm V" first="Volker" last="Sturm">Volker Sturm</name>
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<s2>Cologne</s2>
<s3>DEU</s3>
<sZ>13 aut.</sZ>
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<country>Allemagne</country>
<wicri:noRegion>Cologne</wicri:noRegion>
<wicri:noRegion>Cologne University</wicri:noRegion>
<wicri:noRegion>Cologne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Kupsch, Andreas" sort="Kupsch, Andreas" uniqKey="Kupsch A" first="Andreas" last="Kupsch">Andreas Kupsch</name>
<affiliation wicri:level="3"><inist:fA14 i1="09"><s1>Department of Neurology, Charité Hospital, Humboldt University</s1>
<s2>Berlin</s2>
<s3>DEU</s3>
<sZ>14 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName><region type="land" nuts="3">Berlin</region>
<settlement type="city">Berlin</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Karner, Elfriede" sort="Karner, Elfriede" uniqKey="Karner E" first="Elfriede" last="Karner">Elfriede Karner</name>
<affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Neurology, Innsbruck Medical University</s1>
<s2>Innsbruck</s2>
<s3>AUT</s3>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Autriche</country>
<wicri:noRegion>Innsbruck</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name>
<affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian-Albrechts-University</s1>
<s2>Kiel</s2>
<s3>DEU</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName><region type="land" nuts="2">Schleswig-Holstein</region>
<settlement type="city">Kiel</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Witt, Karsten" sort="Witt, Karsten" uniqKey="Witt K" first="Karsten" last="Witt">Karsten Witt</name>
<affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Neurology, Christian-Albrechts-University</s1>
<s2>Kiel</s2>
<s3>DEU</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
<sZ>3 aut.</sZ>
<sZ>16 aut.</sZ>
<sZ>17 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName><region type="land" nuts="2">Schleswig-Holstein</region>
<settlement type="city">Kiel</settlement>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">Movement disorders</title>
<title level="j" type="abbreviated">Mov. disord.</title>
<idno type="ISSN">0885-3185</idno>
<imprint><date when="2010">2010</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Movement disorders</title>
<title level="j" type="abbreviated">Mov. disord.</title>
<idno type="ISSN">0885-3185</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Cognitive disorder</term>
<term>Nervous system diseases</term>
<term>Parkinson disease</term>
<term>Risk factor</term>
<term>Subthalamic nucleus</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Trouble cognitif</term>
<term>Maladie de Parkinson</term>
<term>Pathologie du système nerveux</term>
<term>Facteur risque</term>
<term>Noyau sousthalamique</term>
</keywords>
</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>
<affiliations><list><country><li>Allemagne</li>
<li>Autriche</li>
</country>
<region><li>Bade-Wurtemberg</li>
<li>Bavière</li>
<li>Berlin</li>
<li>District de Haute-Bavière</li>
<li>District de Karlsruhe</li>
<li>Schleswig-Holstein</li>
</region>
<settlement><li>Berlin</li>
<li>Heidelberg</li>
<li>Kiel</li>
<li>Munich</li>
</settlement>
<orgName><li>Université Louis-et-Maximilien de Munich</li>
</orgName>
</list>
<tree><country name="Allemagne"><region name="Schleswig-Holstein"><name sortKey="Daniels, Christine" sort="Daniels, Christine" uniqKey="Daniels C" first="Christine" last="Daniels">Christine Daniels</name>
</region>
<name sortKey="Botzel, Kai" sort="Botzel, Kai" uniqKey="Botzel K" first="Kai" last="Bötzel">Kai Bötzel</name>
<name sortKey="Danek, Adrian" sort="Danek, Adrian" uniqKey="Danek A" first="Adrian" last="Danek">Adrian Danek</name>
<name sortKey="Deuschl, Gunther" sort="Deuschl, Gunther" uniqKey="Deuschl G" first="Günther" last="Deuschl">Günther Deuschl</name>
<name sortKey="Hilker, Rudiger" sort="Hilker, Rudiger" uniqKey="Hilker R" first="Rüdiger" last="Hilker">Rüdiger Hilker</name>
<name sortKey="Kloss, Manja" sort="Kloss, Manja" uniqKey="Kloss M" first="Manja" last="Kloss">Manja Kloss</name>
<name sortKey="Krack, Paul" sort="Krack, Paul" uniqKey="Krack P" first="Paul" last="Krack">Paul Krack</name>
<name sortKey="Krause, Martin" sort="Krause, Martin" uniqKey="Krause M" first="Martin" last="Krause">Martin Krause</name>
<name sortKey="Kupsch, Andreas" sort="Kupsch, Andreas" uniqKey="Kupsch A" first="Andreas" last="Kupsch">Andreas Kupsch</name>
<name sortKey="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O." last="Pinsker">Markus O. Pinsker</name>
<name sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name>
<name sortKey="Sturm, Volker" sort="Sturm, Volker" uniqKey="Sturm V" first="Volker" last="Sturm">Volker Sturm</name>
<name sortKey="Tronnier, Volker" sort="Tronnier, Volker" uniqKey="Tronnier V" first="Volker" last="Tronnier">Volker Tronnier</name>
<name sortKey="Volkmann, Jens" sort="Volkmann, Jens" uniqKey="Volkmann J" first="Jens" last="Volkmann">Jens Volkmann</name>
<name sortKey="Witt, Karsten" sort="Witt, Karsten" uniqKey="Witt K" first="Karsten" last="Witt">Karsten Witt</name>
<name sortKey="Wojtecki, Lars" sort="Wojtecki, Lars" uniqKey="Wojtecki L" first="Lars" last="Wojtecki">Lars Wojtecki</name>
</country>
<country name="Autriche"><noRegion><name sortKey="Karner, Elfriede" sort="Karner, Elfriede" uniqKey="Karner E" first="Elfriede" last="Karner">Elfriede Karner</name>
</noRegion>
</country>
</tree>
</affiliations>
</record>
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