Movement Disorders Clinic, Strasse nach Fichtenwalde 16, 14547, Beelitz-Heilstaetten, Germany.
Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité University Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
J Neural Transm (Vienna). 2019 Mar;126(3):309-318. doi: 10.1007/s00702-019-01972-7. Epub 2019 Jan 25.
Normal cognition is an established selection criteria for subthalamic (STN) deep brain stimulation (DBS) in Parkinson's disease (PD), while concern has been raised as to aggravated cognitive decline in PD patients following STN-DBS. The present longterm study investigates cognitive status in all patients (n = 104) suffering from PD, who were treated via continuous bilateral STN-DBS between 1997 and 2006 in a single institution. Preoperative neuropsychological results were available in 79/104 of the patients. Thirty-seven of these patients were additionally assessed after 6.3 ± 2.2 years (range 3.6-10.5 years) postsurgery via neuropsychological and motor test batteries, classifying cognitive conditions according to established criteria. At DBS-surgery patients, available for longterm follow-up (n = 37; mean age 67.6 ± 6.9 years, mean disease duration 11.3 ± 4.1 years), showed no (24.3%; 9/37) or mild preoperative cognitive impairment (MCI, 75.7%; 28/37). Postoperatively (mean disease duration: 17.1 ± 5.1 years), 19% of the patients (7/37) had no cognitive impairment, while 41% of the patients presented with either MCI or dementia (15/37, respectively). Preoperative MCI correlated with conversion to dementia by trend. Overall, STN-DBS-treated patients deteriorated by 1.6/140 points/year in the Mattis dementia rating scale. Disease duration, but not age, at DBS-surgery negatively correlated with postoperative cognitive decline and positively correlated with conversion to dementia. This observational, "real-life" study provides longterm results of cognitive decline in STN-DBS-treated patients with presurgical MCI possibly predicting the conversion to dementia. Although, the present data is lacking a control group of medically treated PD patients, comparison with other studies on cognition and PD do not support a disease-modifying effect of STN-DBS on cognitive domains.
正常认知是深部脑刺激（DBS）治疗帕金森病（PD）的既定选择标准，而 STN-DBS 治疗后 PD 患者认知能力下降加重则引起关注。本长期研究调查了 1997 年至 2006 年在一家机构接受连续双侧 STN-DBS 治疗的所有 PD 患者（n=104）的认知状态。79/104 例患者有术前神经心理学结果。其中 37 例患者在术后 6.3±2.2 年（3.6-10.5 年）进行了神经心理学和运动测试的评估，并根据既定标准对认知情况进行分类。在 DBS 手术患者中，有 37 例患者可进行长期随访（平均年龄 67.6±6.9 岁，平均病程 11.3±4.1 年），他们术前无认知障碍（24.3%；9/37）或轻度认知障碍（75.7%；28/37）。术后（平均病程：17.1±5.1 年），37 例患者中有 19%（7/37）无认知障碍，而 41%（15/37）患者存在 MCI 或痴呆。术前 MCI 呈向痴呆转化的趋势。总的来说，STN-DBS 治疗患者的 Mattis 痴呆评定量表评分每年下降 1.6/140 分。病程而非年龄与术后认知下降呈负相关，与向痴呆转化呈正相关。这项观察性、“真实世界”研究提供了术前 MCI 的 STN-DBS 治疗患者认知下降的长期结果，可能预示着向痴呆的转化。虽然目前的数据缺乏接受药物治疗的 PD 患者的对照组，但与其他认知和 PD 研究的比较并不支持 STN-DBS 对认知领域具有疾病修饰作用。
