School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, Maastricht, the Netherlands.
School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands; Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
Clin Neurol Neurosurg. 2021 Jan;200:106341. doi: 10.1016/j.clineuro.2020.106341. Epub 2020 Nov 3.
Despite optimal improvement in motor functioning, both short- and long-term studies have reported small but consistent changes in cognitive functioning following STN-DBS in Parkinson's disease (PD). The aim of the present study was to explore whether surgical characteristics were associated with cognitive decline one year following STN-DBS.
We retrospectively analyzed 49 PD patients who underwent bilateral STN-DBS. Cognitive change scores were related to the number of microelectrode recording (MER) trajectories, the STN length as measured by MER, and cortical entry points. Regression analyses were corrected for age at surgery, disease duration, education and preoperative levodopa responsiveness. Patients were then divided into a cognitive and non-cognitive decline group for each neuropsychological test and compared regarding demographic and surgical characteristics.
One year postoperatively, significant declines were found in verbal fluency, Stroop Color-Word test and Trail Making Test B (TMT-B). Only changes in TMT-B were associated with the coronal entry point in the right hemisphere. The number of MER trajectories and STN length were not associated with cognitive change scores. When comparing the cognitive decline and non-cognitive decline groups, no significant differences were found in surgical characteristics.
The electrode passage through the right prefrontal lobe may contribute to subtle changes in executive function. However, only few patients showed clinically relevant cognitive decline. The use of multiple MER trajectories and a longer STN length were not associated with cognitive decline one year following surgery. From a cognitive point of view, DBS may be considered a relatively safe procedure.
尽管运动功能得到了最佳改善，但短期和长期研究都报告了在帕金森病（PD）患者接受 STN-DBS 后认知功能出现小但持续的变化。本研究旨在探讨手术特征是否与 STN-DBS 后一年的认知下降有关。
我们回顾性分析了 49 例接受双侧 STN-DBS 的 PD 患者。认知变化评分与微电极记录（MER）轨迹数量、MER 测量的 STN 长度和皮质进入点有关。回归分析校正了手术时的年龄、疾病持续时间、教育程度和术前左旋多巴反应性。然后，根据每个神经心理学测试将患者分为认知和非认知下降组，并比较了人口统计学和手术特征。
术后 1 年，言语流畅性、Stroop 颜色-词测试和 TMT-B 测试显著下降。只有右侧半球冠状进入点与 TMT-B 的变化相关。MER 轨迹数量和 STN 长度与认知变化评分无关。在比较认知下降组和非认知下降组时，手术特征无显著差异。
电极通过右前额叶可能导致执行功能的细微变化。然而，只有少数患者出现了临床相关的认知下降。使用多个 MER 轨迹和较长的 STN 长度与术后 1 年的认知下降无关。从认知的角度来看，DBS 可能被认为是一种相对安全的手术。
