Yamanaka Takehiko, Ishii Fumiyasu, Umemura Atsushi, Miyata Miwako, Horiba Mitsuya, Oka Yuichi, Yamada Kazuo, Okita Kenji, Matsukawa Noriyuki, Ojika Kosei
Department of Neurology, Nagoya City University, 1 Kawasumi, Mizuho-ku, Nagoya 467-8601, Japan.
Clin Neurol Neurosurg. 2012 May;114(4):347-51. doi: 10.1016/j.clineuro.2011.11.009. Epub 2011 Dec 15.
OBJECTIVE: Selective impairment of executive function has been shown in Parkinson's Disease (PD) patients undergoing Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN). However, some patients experience difficulties in daily life, such as dissension in interpersonal relationships or a loss of lifestyle balance, in the short term after surgery. Our hypothesis is that these difficulties might be related to executive dysfunction. To elucidate the involvement of executive dysfunction in these difficulties, we assessed motor and executive function in the short term and long term after surgery. METHODS: We examined motor function and executive function in 30 patients who underwent bilateral STN-DBS for medically refractory PD. Patients were evaluated for executive function 1 month before surgery, 1 month after surgery, and 12 months after surgery using the Trail Making Test (TMT), the Modified Stroop Color Word Interference Test (MST) and tests of Verbal Fluency (VF). RESULTS: TMT-B, TMT (B/A), MST-B, VF-phonemic and VF-semantic scores were significantly poorer 1 month after STN-DBS. TMT-B, TMT (B/A) and VF-phonemic recovered to preoperative levels by 12 months after surgery. A reduction in dopaminergic medication 1 month after surgery was significantly correlated with deterioration of TMT (B/A). CONCLUSION: Temporary deterioration of executive function may occur in the short term after STN-DBS, whereas motor function is usually improved. PD patients undergoing STN-DBS should be managed during this period to better predict temporary executive dysfunction. Excessive reduction of dopaminergic medication after surgery might, at least in part, result in this deterioration of executive function.
目的:已证实接受丘脑底核(STN)深部脑刺激(DBS)的帕金森病(PD)患者存在执行功能的选择性损害。然而,一些患者在术后短期内会出现日常生活困难,如人际关系冲突或生活方式失衡。我们的假设是,这些困难可能与执行功能障碍有关。为了阐明执行功能障碍在这些困难中的作用,我们评估了手术短期和长期后的运动功能和执行功能。 方法:我们对30例因药物难治性PD接受双侧STN-DBS的患者进行了运动功能和执行功能检查。使用连线测验(TMT)、改良斯特鲁普色词干扰测验(MST)和言语流畅性(VF)测试,在术前1个月、术后1个月和术后12个月对患者的执行功能进行评估。 结果:STN-DBS术后1个月,TMT-B、TMT(B/A)、MST-B、VF-音素和VF-语义评分显著较差。术后12个月,TMT-B、TMT(B/A)和VF-音素恢复到术前水平。术后1个月多巴胺能药物减少与TMT(B/A)恶化显著相关。 结论:STN-DBS术后短期内可能会出现执行功能的暂时恶化,而运动功能通常会改善。在此期间应对接受STN-DBS的PD患者进行管理,以更好地预测暂时的执行功能障碍。术后多巴胺能药物过度减少可能至少部分导致这种执行功能恶化。
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