丘脑底核深部脑刺激对孤立性肌张力障碍双任务认知和运动表现的影响。
Effect of subthalamic nucleus deep brain stimulation on dual-task cognitive and motor performance in isolated dystonia.
作者信息
Mills Kelly A, Markun Leslie C, San Luciano Marta, Rizk Rami, Allen I Elaine, Racine Caroline A, Starr Philip A, Alberts Jay L, Ostrem Jill L
机构信息
Department of Neurology, University of California, San Francisco, California, USA Parkinson's Disease Research, Education, and Clinical Center, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
Department of Neurology, University of California, San Francisco, California, USA.
出版信息
J Neurol Neurosurg Psychiatry. 2015 Apr;86(4):404-9. doi: 10.1136/jnnp-2014-307942. Epub 2014 Jul 10.
OBJECTIVE
Subthalamic nucleus (STN) deep brain stimulation (DBS) can improve motor complications of Parkinson's disease (PD) but may worsen specific cognitive functions. The effect of STN DBS on cognitive function in dystonia patients is less clear. Previous reports indicate that bilateral STN stimulation in patients with PD amplifies the decrement in cognitive-motor dual-task performance seen when moving from a single-task to dual-task paradigm. We aimed to determine if the effect of bilateral STN DBS on dual-task performance in isolated patients with dystonia, who have less cognitive impairment and no dementia, is similar to that seen in PD.
METHODS
Eight isolated predominantly cervical patients with dystonia treated with bilateral STN DBS, with average dystonia duration of 10.5 years and Montreal Cognitive Assessment score of 26.5, completed working memory (n-back) and motor (forced-maintenance) tests under single-task and dual-task conditions while on and off DBS.
RESULTS
A multivariate, repeated-measures analysis of variance showed no effect of stimulation status (On vs Off) on working memory (F=0.75, p=0.39) or motor function (F=0.22, p=0.69) when performed under single-task conditions, though as working memory task difficulty increased, stimulation disrupted the accuracy of force-tracking. There was a very small worsening in working memory performance (F=9.14, p=0.019) when moving from single-task to dual-tasks when using the 'dual-task loss' analysis.
CONCLUSIONS
This study suggests the effect of STN DBS on working memory and attention may be much less consequential in patients with dystonia than has been reported in PD.
目的
丘脑底核（STN）深部脑刺激（DBS）可改善帕金森病（PD）的运动并发症，但可能会使特定认知功能恶化。STN DBS对肌张力障碍患者认知功能的影响尚不清楚。先前的报告表明，PD患者双侧STN刺激会加剧从单任务模式转变为双任务模式时出现的认知-运动双任务表现下降。我们旨在确定双侧STN DBS对孤立的肌张力障碍患者双任务表现的影响，这些患者认知障碍较轻且无痴呆，是否与PD患者相似。
方法
8例接受双侧STN DBS治疗的主要为颈部肌张力障碍的孤立患者，平均肌张力障碍病程为10.5年，蒙特利尔认知评估得分为26.5，在DBS开启和关闭状态下，于单任务和双任务条件下完成工作记忆（n-back）和运动（强制维持）测试。
结果
多变量重复测量方差分析显示，在单任务条件下进行测试时，刺激状态（开启与关闭）对工作记忆（F=0.75，p=0.39）或运动功能（F=0.22，p=0.69）无影响，不过随着工作记忆任务难度增加，刺激会干扰力量跟踪的准确性。采用“双任务损失”分析时，从单任务转变为双任务时，工作记忆表现有非常小的恶化（F=9.14，p=0.019）。
结论
本研究表明，STN DBS对肌张力障碍患者工作记忆和注意力的影响可能远小于在PD患者中所报告的影响。
Zotero 插件