Risk Factors for Executive Dysfunction After Subthalamic Nucleus Stimulation in Parkinson's Disease
Identifieur interne : 000854 ( PascalFrancis/Checkpoint ); précédent : 000853; suivant : 000855Risk 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.
Affiliations:
- Allemagne, Autriche
- Bade-Wurtemberg, Bavière, Berlin, District de Haute-Bavière, District de Karlsruhe, Schleswig-Holstein
- Berlin, Heidelberg, Kiel, Munich
- Université Louis-et-Maximilien de Munich
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<record><TEI><teiHeader><fileDesc><titleStmt><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><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="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><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="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><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="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O." last="Pinsker">Markus O. 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sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurology, Heinrich Heine University</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Dusseldorf</wicri:noRegion><wicri:noRegion>Heinrich Heine University</wicri:noRegion><wicri:noRegion>Dusseldorf</wicri:noRegion></affiliation></author><author><name sortKey="Wojtecki, Lars" sort="Wojtecki, Lars" uniqKey="Wojtecki L" first="Lars" last="Wojtecki">Lars Wojtecki</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurology, Heinrich Heine University</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Dusseldorf</wicri:noRegion><wicri:noRegion>Heinrich Heine University</wicri:noRegion><wicri:noRegion>Dusseldorf</wicri:noRegion></affiliation></author><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><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><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><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><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></inist:fA14><country>Allemagne</country><wicri:noRegion>Cologne</wicri:noRegion><wicri:noRegion>Cologne University</wicri:noRegion><wicri:noRegion>Cologne</wicri:noRegion></affiliation></author><author><name sortKey="Sturm, Volker" sort="Sturm, Volker" uniqKey="Sturm V" first="Volker" last="Sturm">Volker Sturm</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Neurosurgery, Cologne University</s1><s2>Cologne</s2><s3>DEU</s3><sZ>13 aut.</sZ></inist:fA14><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></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">10-0413277</idno><date when="2010">2010</date><idno type="stanalyst">PASCAL 10-0413277 INIST</idno><idno type="RBID">Pascal:10-0413277</idno><idno type="wicri:Area/PascalFrancis/Corpus">000961</idno><idno type="wicri:Area/PascalFrancis/Curation">002358</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000854</idno></publicationStmt><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><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="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><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="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><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="Pinsker, Markus O" sort="Pinsker, Markus O" uniqKey="Pinsker M" first="Markus O." last="Pinsker">Markus O. Pinsker</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Christian-Albrechts-University</s1><s2>Kiel</s2><s3>DEU</s3><sZ>4 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="Krause, Martin" sort="Krause, Martin" uniqKey="Krause M" first="Martin" last="Krause">Martin Krause</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Neurology, Heidelberg University</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Tronnier, Volker" sort="Tronnier, Volker" uniqKey="Tronnier V" first="Volker" last="Tronnier">Volker Tronnier</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Neurosurgery, Heidelberg University</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>6 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Kloss, Manja" sort="Kloss, Manja" uniqKey="Kloss M" first="Manja" last="Kloss">Manja Kloss</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Neurology, Heidelberg University</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bade-Wurtemberg</region><region type="district" nuts="2">District de Karlsruhe</region><settlement type="city">Heidelberg</settlement></placeName></affiliation></author><author><name sortKey="Schnitzler, Alfons" sort="Schnitzler, Alfons" uniqKey="Schnitzler A" first="Alfons" last="Schnitzler">Alfons Schnitzler</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurology, Heinrich Heine University</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Dusseldorf</wicri:noRegion><wicri:noRegion>Heinrich Heine University</wicri:noRegion><wicri:noRegion>Dusseldorf</wicri:noRegion></affiliation></author><author><name sortKey="Wojtecki, Lars" sort="Wojtecki, Lars" uniqKey="Wojtecki L" first="Lars" last="Wojtecki">Lars Wojtecki</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurology, Heinrich Heine University</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Dusseldorf</wicri:noRegion><wicri:noRegion>Heinrich Heine University</wicri:noRegion><wicri:noRegion>Dusseldorf</wicri:noRegion></affiliation></author><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><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><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><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><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></inist:fA14><country>Allemagne</country><wicri:noRegion>Cologne</wicri:noRegion><wicri:noRegion>Cologne University</wicri:noRegion><wicri:noRegion>Cologne</wicri:noRegion></affiliation></author><author><name sortKey="Sturm, Volker" sort="Sturm, Volker" uniqKey="Sturm V" first="Volker" last="Sturm">Volker Sturm</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Department of Neurosurgery, Cologne University</s1><s2>Cologne</s2><s3>DEU</s3><sZ>13 aut.</sZ></inist:fA14><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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0885-3185</s0></fA01><fA03 i2="1"><s0>Mov. disord.</s0></fA03><fA05><s2>25</s2></fA05><fA06><s2>11</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Risk Factors for Executive Dysfunction After Subthalamic Nucleus Stimulation in Parkinson's Disease</s1></fA08><fA11 i1="01" i2="1"><s1>DANIELS (Christine)</s1></fA11><fA11 i1="02" i2="1"><s1>KRACK (Paul)</s1></fA11><fA11 i1="03" i2="1"><s1>VOLKMANN (Jens)</s1></fA11><fA11 i1="04" i2="1"><s1>PINSKER (Markus O.)</s1></fA11><fA11 i1="05" i2="1"><s1>KRAUSE (Martin)</s1></fA11><fA11 i1="06" i2="1"><s1>TRONNIER (Volker)</s1></fA11><fA11 i1="07" i2="1"><s1>KLOSS (Manja)</s1></fA11><fA11 i1="08" i2="1"><s1>SCHNITZLER (Alfons)</s1></fA11><fA11 i1="09" i2="1"><s1>WOJTECKI (Lars)</s1></fA11><fA11 i1="10" i2="1"><s1>BÖTZEL (Kai)</s1></fA11><fA11 i1="11" i2="1"><s1>DANEK (Adrian)</s1></fA11><fA11 i1="12" i2="1"><s1>HILKER (Rüdiger)</s1></fA11><fA11 i1="13" i2="1"><s1>STURM (Volker)</s1></fA11><fA11 i1="14" i2="1"><s1>KUPSCH (Andreas)</s1></fA11><fA11 i1="15" i2="1"><s1>KARNER (Elfriede)</s1></fA11><fA11 i1="16" i2="1"><s1>DEUSCHL (Günther)</s1></fA11><fA11 i1="17" i2="1"><s1>WITT (Karsten)</s1></fA11><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></fA14><fA14 i1="02"><s1>Department of Neurosurgery, Christian-Albrechts-University</s1><s2>Kiel</s2><s3>DEU</s3><sZ>4 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Neurology, Heidelberg University</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>5 aut.</sZ><sZ>7 aut.</sZ></fA14><fA14 i1="04"><s1>Department of Neurosurgery, Heidelberg University</s1><s2>Heidelberg</s2><s3>DEU</s3><sZ>6 aut.</sZ></fA14><fA14 i1="05"><s1>Department of Neurology, Heinrich Heine University</s1><s2>Dusseldorf</s2><s3>DEU</s3><sZ>8 aut.</sZ><sZ>9 aut.</sZ></fA14><fA14 i1="06"><s1>Department of Neurology, Ludwig-Maximilians-University</s1><s2>Munich</s2><s3>DEU</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></fA14><fA14 i1="07"><s1>Department of Neurology, Cologne University</s1><s2>Cologne</s2><s3>DEU</s3><sZ>12 aut.</sZ></fA14><fA14 i1="08"><s1>Department of Neurosurgery, Cologne University</s1><s2>Cologne</s2><s3>DEU</s3><sZ>13 aut.</sZ></fA14><fA14 i1="09"><s1>Department of Neurology, Charité Hospital, Humboldt University</s1><s2>Berlin</s2><s3>DEU</s3><sZ>14 aut.</sZ></fA14><fA14 i1="10"><s1>Department of Neurology, Innsbruck Medical University</s1><s2>Innsbruck</s2><s3>AUT</s3><sZ>15 aut.</sZ></fA14><fA20><s1>1583-1589</s1></fA20><fA21><s1>2010</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>20953</s2><s5>354000192608100080</s5></fA43><fA44><s0>0000</s0><s1>© 2010 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>35 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>10-0413277</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Movement disorders</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17</s0></fC02><fC02 i1="02" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Trouble cognitif</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Cognitive disorder</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Trastorno cognitivo</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Maladie de Parkinson</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Parkinson disease</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Facteur risque</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Risk factor</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Factor riesgo</s0><s5>09</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Noyau sousthalamique</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Subthalamic nucleus</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Núcleo subtalámico</s0><s5>10</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Encéphale</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Encephalon</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Encéfalo</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux central</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Central nervous system</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervioso central</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Syndrome extrapyramidal</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>41</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>42</s5></fC07><fN21><s1>270</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><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>Pour manipuler ce document sous Unix (Dilib)
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