Blume J, Lange M, Rothenfusser E, Doenitz C, Bogdahn U, Brawanski A, Schlaier J
Department of Neurology, University of Regensburg, Medical Center, Germany; Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany.
Center for Deep Brain Stimulation, University of Regensburg, Medical Center, Germany; Department of Neurosurgery, University of Regensburg, Medical Center, Germany.
Clin Neurol Neurosurg. 2017 Aug;159:87-92. doi: 10.1016/j.clineuro.2017.05.023. Epub 2017 May 31.
White Matter lesions (WML) are a risk factor for cognitive impairment in Parkinson's disease. There is no clear evidence of reduced general cognitive function after DBS. However, a subgroup of patients develops dementia rapidly after DBS despite careful patient selection processes. The aim of this study was to evaluate the load of WML as a possible risk factor for cognitive decline following STN DBS.
40 PD-patients receiving bilateral STN-DBS were followed at least three years after surgery to detect dementia. All patients underwent comprehensive neuropsychological assessment and MRI before surgery. The extent of WML was assessed using an automated approach. WML volume was correlated to the onset of dementia and the decline of a cognitive composite score retrospectively.
Patients with a rapid onset of dementia within one, respective three following DBS showed significant higher WML volumes compared to cognitive normal and MCI patients (55.8cm±18.836 vs. 9.3cm±12.2; p=0.002). The same significant association was found in a multivariable model, including the covariables age, gender and PD disease duration (p=0.01). WML volume was associated to the rate of decline in cognitive composite score within three years after DBS surgery (p=0.006; R=0.40) after correction for age.
Damaged white matter may lead to a reduced compensation of disconnections in cognitive circuits caused by the implantation of the DBS electrodes or by chronic stimulation. The role of WML as a prognostic factor for the cognitive outcome after DBS may be underestimated. The WML burden should be taken seriously in preoperative risk stratification.
脑白质病变（WML）是帕金森病认知障碍的一个危险因素。目前尚无明确证据表明脑深部电刺激（DBS）后一般认知功能会降低。然而，尽管有仔细的患者选择过程，但仍有一部分患者在DBS后迅速发展为痴呆。本研究的目的是评估WML负荷作为丘脑底核DBS后认知衰退的一个可能危险因素。
40例接受双侧丘脑底核DBS的帕金森病患者在术后至少随访三年以检测痴呆。所有患者在手术前均接受了全面的神经心理学评估和磁共振成像（MRI）检查。采用自动方法评估WML的范围。回顾性分析WML体积与痴呆发病及认知综合评分下降的相关性。
与认知正常和轻度认知障碍（MCI）患者相比，在DBS后1年或3年内迅速发生痴呆的患者WML体积显著更高（55.8cm±18.836 vs. 9.3cm±12.2；p=0.002）。在包括年龄、性别和帕金森病病程等协变量的多变量模型中也发现了同样显著的关联（p=0.01）。在校正年龄后，WML体积与DBS手术后三年内认知综合评分的下降率相关（p=0.006；R=0.40）。
受损的白质可能导致因DBS电极植入或慢性刺激引起的认知回路中连接中断的代偿能力下降。WML作为DBS后认知结果的一个预后因素的作用可能被低估。在术前风险分层中应认真考虑WML负担。
