Castelli L, Perozzo P, Zibetti M, Crivelli B, Morabito U, Lanotte M, Cossa F, Bergamasco B, Lopiano L
Department of Neuroscience, University of Turin, Italy.
Eur Neurol. 2006;55(3):136-44. doi: 10.1159/000093213. Epub 2006 May 8.
To evaluate modifications occurring in cognitive functions and behavioural aspects in a group of 72 consecutive patients with Parkinson's disease (PD) 15 months after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN).
72 consecutive PD patients bilaterally implanted for DBS of the STN were evaluated before and after surgery with a mean follow-up of 15 months. A neuropsychological assessment was performed to evaluate reasoning (Raven Colour Matrices), memory (Bisyllabic Word Repetition Test, Corsi's Block-Tapping Test, Paired-Associate Learning) and frontal executive functions (Trail Making Test Part B, Nelson Modified Card Sorting Test, phonemic and category verbal fluency tasks). Mood and suicidal ideation were evaluated using the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory and personality traits were evaluated with the Structured Clinical Interview for the DSM-III-R Axis II Disorders (SCID-II). Assessment of thought disorders and apathy was based on subitems of the Unified Parkinson's Disease Rating Scale.
The comparisons between pre- and postoperative neuropsychological test scores showed a significant worsening only in phonemic and semantic verbal fluency tasks, while fewer errors were found in the Nelson Modified Card Sorting Test. Globally, behavioural assessment evidenced a small improvement in mood, as assessed by the BDI, in obsessive-compulsive and paranoid personality traits (SCID-II). Thought disorders worsened while suicidal ideation, anxiety and apathy showed no postoperative modifications. The analysis of individual outcomes (+/-1 SD criterion) evidenced a relevant postoperative cognitive decline in 3 patients out of 65 (4.5%). Moreover, following implantation, 1 patients exhibited psychosis (1.5%), 2 patients experienced a clinically relevant worsening of depressive symptoms (3%), 7 patients showed an increase in anxiety (12%) and 3 patients a worsening in depression and anxiety symptoms (3%). On the contrary, 12 patients (20%) showed a relevant improvement in mood and 14 patients (23%) a relevant reduction of anxiety symptoms after the surgery.
The present study confirms that STN DBS is cognitively safe since the only relevant change observed was a mild decrease in verbal fluency tasks. Globally, a small postoperative improvement was found in the BDI, and in two SCID-II subscales concerning obsessive-compulsive and paranoid personality traits, even though postoperative behavioural disturbances can occur in individual patients.
评估72例连续的帕金森病（PD）患者在丘脑底核（STN）双侧深部脑刺激（DBS）15个月后认知功能和行为方面发生的改变。
对72例连续接受STN双侧植入DBS的PD患者在手术前后进行评估，平均随访15个月。进行神经心理学评估以评估推理能力（瑞文彩色推理测验）、记忆力（双音节词重复测验、 Corsi方块敲击测验、配对联想学习）和额叶执行功能（连线测验B、尼尔森改良卡片分类测验、音素和类别言语流畅性任务）。使用贝克抑郁量表（BDI）评估情绪和自杀观念。通过状态-特质焦虑量表测量焦虑，并用DSM-III-R轴II障碍的结构化临床访谈（SCID-II）评估人格特质。基于统一帕金森病评定量表的子项目评估思维障碍和淡漠。
术前和术后神经心理学测试分数的比较显示，仅在音素和语义言语流畅性任务中有显著恶化，而在尼尔森改良卡片分类测验中错误减少。总体而言，行为评估表明，通过BDI评估，情绪有小幅改善，在强迫和偏执型人格特质（SCID-II）方面也有改善。思维障碍恶化，而自杀观念、焦虑和淡漠在术后没有变化。对个体结果的分析（±1标准差标准）表明，65例患者中有3例（4.5%）术后出现明显的认知下降。此外，植入后，1例患者出现精神病（1.5%），2例患者出现临床上有意义的抑郁症状恶化（3%），7例患者焦虑增加（12%），3例患者抑郁和焦虑症状恶化（3%）。相反，12例患者（20%）术后情绪有明显改善，14例患者（23%）术后焦虑症状明显减轻。
本研究证实STN DBS在认知方面是安全的，因为观察到的唯一相关变化是言语流畅性任务有轻度下降。总体而言，BDI以及关于强迫和偏执型人格特质的两个SCID-II子量表在术后有小幅改善，尽管个别患者术后可能出现行为障碍。
