McInerney Shane J, McNeely Heather E, Geraci Joseph, Giacobbe Peter, Rizvi Sakina J, Ceniti Amanda K, Cyriac Anna, Mayberg Helen S, Lozano Andres M, Kennedy Sidney H
Department of Psychiatry, University Health NetworkToronto, ON, Canada; Faculty of Medicine, University of TorontoToronto, ON, Canada; Department of Psychiatry, St. Michael's HospitalToronto, ON, Canada; Arthur Sommer Rotenberg Suicide and Depression Studies Program, St. Michael's HospitalToronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's HospitalToronto, ON, Canada; Krembil Research Institute, University Health NetworkToronto, ON, Canada.
Faculty of Medicine, University of TorontoToronto, ON, Canada; Department of Psychiatry and Behavioral Neuroscience, McMaster UniversityHamilton, ON, Canada.
Front Hum Neurosci. 2017 Feb 24;11:74. doi: 10.3389/fnhum.2017.00074. eCollection 2017.
Deep brain stimulation (DBS) is a neurosurgical intervention with demonstrated effectiveness for treatment resistant depression (TRD), but longitudinal studies on the stability of cognitive parameters following treatment are limited. The objectives of this study are to (i) identify baseline cognitive predictors of treatment response to subcallosal cingulate gyrus (SCG) DBS for unipolar TRD and (ii) compare neurocognitive performance prior to and 12 months after DBS implantation. Twenty unipolar TRD patients received SCG DBS for 12 months. A standardized neuropsychological battery was used to assess a range of neurocognitive abilities at baseline and after 12 months. Severity of depression was evaluated using the 17 item Hamilton Rating Scale for Depression. Finger Tap-Dominant Hand Test and total number of errors made on the Wisconsin Card Sorting Test predicted classification of patients as treatment responders or non-responders, and were independent of improvement in mood. Change in verbal fluency was the only neuropsychological test that correlated with change in mood from baseline to the follow up period. None of the neuropsychological measures displayed deterioration in cognitive functioning from baseline to repeat testing at 12 months. This was an open label study with a small sample size which limits predictive analysis. Practice effects of the neuropsychological testing could explain the improvement from baseline to follow up on some tasks. Replication using a larger sample of subjects who received neuropsychological testing before and at least 12 months after DBS surgery is required. These preliminary results (i) suggest that psychomotor speed may be a useful baseline predictor of response to SCG DBS treatment and (ii) support previous suggestions that SCG DBS has no deleterious effects on cognition.
深部脑刺激（DBS）是一种神经外科干预手段，已证明对难治性抑郁症（TRD）有效，但关于治疗后认知参数稳定性的纵向研究有限。本研究的目的是：（i）确定单极TRD患者对扣带回下沟（SCG）DBS治疗反应的基线认知预测指标；（ii）比较DBS植入术前和术后12个月的神经认知表现。20名单极TRD患者接受了12个月的SCG DBS治疗。使用标准化神经心理成套测验在基线和12个月后评估一系列神经认知能力。使用17项汉密尔顿抑郁评定量表评估抑郁严重程度。优势手手指敲击测试和威斯康星卡片分类测试的错误总数可预测患者是治疗反应者还是无反应者，且与情绪改善无关。言语流畅性变化是唯一一项与基线至随访期情绪变化相关的神经心理测试。从基线到12个月重复测试，没有一项神经心理测量显示认知功能恶化。这是一项开放标签研究，样本量小，限制了预测分析。神经心理测试的练习效应可能解释了一些任务从基线到随访的改善情况。需要使用更大样本的受试者进行重复研究，这些受试者在DBS手术前和术后至少12个月接受神经心理测试。这些初步结果：（i）表明精神运动速度可能是SCG DBS治疗反应的有用基线预测指标；（ii）支持先前关于SCG DBS对认知无有害影响的观点。
