丘脑底核深部脑刺激对帕金森病患者认知功能的影响。
Influence of deep brain stimulation of the subthalamic nucleus on cognitive function in patients with Parkinson's disease.
作者信息
Wu Bin, Han Lu, Sun Bo-Min, Hu Xiao-Wu, Wang Xiao-Ping
机构信息
Department of Neurology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200080, China.
出版信息
Neurosci Bull. 2014 Feb;30(1):153-61. doi: 10.1007/s12264-013-1389-9. Epub 2013 Dec 12.
Deep brain stimulation (DBS) is an effective technique for treating Parkinson's disease (PD) in the middle and advanced stages. The subthalamic nucleus (STN) is the most common target for clinical treatment using DBS. While STN-DBS can significantly improve motor symptoms in PD patients, adverse cognitive effects have also been reported. The specific effects of STN-DBS on cognitive function and the related mechanisms remain unclear. Thus, it is imperative to identify the influence of STN-DBS on cognition and investigate the potential mechanisms to provide a clearer view of the various cognitive sequelae in PD patients. For this review, a literature search was performed using the following inclusion criteria: (1) at least 10 patients followed for a mean of at least 6 months after surgery since the year 2006; (2) pre- and postoperative cognitive data using at least one standardized neuropsychological scale; and (3) adequate reporting of study results using means and standard deviations. Of ∼170 clinical studies identified, 25 cohort studies (including 15 self-controlled studies, nine intergroup controlled studies, and one multi-center, randomized control experiment) and one meta-analysis were eligible for inclusion. The results suggest that the precise mechanism of the changes in cognitive function after STN-DBS remains obscure, but STN-DBS certainly has effects on cognition. In particular, a progressive decrease in verbal fluency after STN-DBS is consistently reported and although executive function is unchanged in the intermediate stage postoperatively, it tends to decline in the early and later stages. However, these changes do not affect the improvements in quality of life. STN-DBS seems to be safe with respect to cognitive effects in carefully-selected patients during a follow-up period from 6 months to 9 years.
深部脑刺激(DBS)是治疗中晚期帕金森病(PD)的一种有效技术。丘脑底核(STN)是临床使用DBS治疗最常见的靶点。虽然STN-DBS能显著改善PD患者的运动症状,但也有不良认知效应的报道。STN-DBS对认知功能的具体影响及其相关机制仍不清楚。因此,必须明确STN-DBS对认知的影响,并研究潜在机制,以便更清楚地了解PD患者的各种认知后遗症。在本次综述中,我们按照以下纳入标准进行文献检索:(1)自2006年以来,至少10例患者术后平均随访至少6个月;(2)使用至少一种标准化神经心理量表的术前和术后认知数据;(3)使用均值和标准差充分报告研究结果。在检索到的约170项临床研究中,有25项队列研究(包括15项自身对照研究、9项组间对照研究和1项多中心随机对照实验)和1项荟萃分析符合纳入标准。结果表明,STN-DBS术后认知功能改变的确切机制仍不清楚,但STN-DBS肯定对认知有影响。特别是,STN-DBS术后言语流畅性持续下降,虽然术后中期执行功能未改变,但在早期和后期有下降趋势。然而,这些变化并不影响生活质量改善。在6个月至9年的随访期内,对于精心挑选的患者,STN-DBS在认知效应方面似乎是安全的。