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与药物治疗相比,丘脑底核脑深部电刺激对帕金森病患者神经认知功能的影响:一项荟萃分析。

Effects of Deep Brain Stimulation in the Subthalamic Nucleus on Neurocognitive Function in Patients With Parkinson's Disease Compared With Medical Therapy: A Meta-Analysis.

作者信息

Wang Jiazhen, Pan Ru, Cui Ying, Wang Zhigang, Li Qinghua

机构信息

Department of Neurology, Affiliated Hospital of Guilin Medical University, Guilin Medical University, Guilin, China.

Pathology Department of Huzhou Central Hospital, Huzhou, China.

出版信息

Front Neurol. 2021 Mar 2;12:610840. doi: 10.3389/fneur.2021.610840. eCollection 2021.

Abstract

DBS has been shown to significantly affect motor symptoms in Parkinson's disease (PD). However, some studies have suggested that it may have adverse effects on patients' neurocognitive function. To clarify this operation's effect on neurocognitive function, we collected studies containing neurocognitive function evaluation for qualitative and quantitative analysis. We searched relevant clinical studies through Pubmed and Embase databases and extracted and sorted out information such as sample size, post-operative scores, pre-operative and post-operative evaluation interval, PD course, and exclusion criteria, from articles meeting the standards. The magnitude and variance of the DBS group's combined effects and the drug therapy group in each neurocognitive domain were calculated and analyzed by the random-effects model. Compared with the drug treatment group, the verbal fluency of patients in the experimental group was significantly decreased at least moderately (ES = -0.553), in which the phonemic fluency declines greatly (ES = -0.842), learning and memory ability was slightly decreased (ES = -0.305), and other neurocognitive functions were not significantly decreased. STN-DBS can affect verbal fluency and damage learning and memory. There was no significant correlation between the above effects and disease progression itself, and it was more likely to be associated with STN-DBS. It is suggested that post-operative patients should be trained and evaluated regularly for their verbal fluency and learning and memory ability. The safety of STN-DBS is acceptable for the majority of patients with motor symptoms.

摘要

已证明脑深部电刺激(DBS)可显著影响帕金森病(PD)的运动症状。然而,一些研究表明,它可能对患者的神经认知功能产生不利影响。为阐明该手术对神经认知功能的影响,我们收集了包含神经认知功能评估的研究进行定性和定量分析。我们通过Pubmed和Embase数据库检索相关临床研究,并从符合标准的文章中提取并整理样本量、术后评分、术前和术后评估间隔、PD病程及排除标准等信息。采用随机效应模型计算并分析DBS组与药物治疗组在各神经认知领域的合并效应量及方差。与药物治疗组相比,实验组患者的言语流畅性至少中度显著下降(效应量ES = -0.553),其中音素流畅性下降幅度较大(ES = -0.842),学习和记忆能力略有下降(ES = -0.305),其他神经认知功能无显著下降。丘脑底核脑深部电刺激(STN-DBS)可影响言语流畅性并损害学习和记忆。上述影响与疾病进展本身无显著相关性,更可能与STN-DBS有关。建议术后患者应定期接受言语流畅性及学习和记忆能力的训练与评估。对于大多数有运动症状的患者而言,STN-DBS的安全性是可以接受的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fa5f/7960912/abfee22f7e29/fneur-12-610840-g0001.jpg

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