Kübler Dorothee, Wellmann Sophie Katharina, Kaminski Jakob, Skowronek Cornelia, Schneider Gerd-Helge, Neumann Wolf-Julian, Ritter Kerstin, Kühn Andrea
Movement Disorder and Neuromodulation Unit, Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.
Movement Disorder and Neuromodulation Unit, Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.
Parkinsonism Relat Disord. 2022 Jan;94:89-95. doi: 10.1016/j.parkreldis.2021.12.002. Epub 2021 Dec 8.
Subthalamic DBS in Parkinson's disease has been associated with cognitive decline in few cases. Volume reduction of the nucleus basalis of Meynert (NBM) seems to precede cognitive impairment in Parkinson's disease. In this retrospective study, we evaluated NBM volume as a predictor of cognitive outcome 1 year after subthalamic DBS.
NBM volumes were calculated from preoperative MRIs using voxel-based morphometry. Cognitive outcome was defined as the relative change of MMSE or DemTect scores from pre-to 1 year postoperatively. A multiple linear regression analysis adjusted for the number of cognitive domains affected in the preoperative neuropsychological testing and UPDRS III was conducted. To account for other variables and potential non-linear effects, an additional machine learning analysis using random forests was applied.
55 patients with Parkinson's disease (39 male, age 61.4 ± 7.5 years, disease duration 10.8 ± 4.7 years) who received bilateral subthalamic DBS electrodes at our center were included. Although overall cognition did not change significantly, individual change in cognitive abilities was variable. Cognitive outcome could be predicted based on NBM size (B = 208.98, p = 0.022*) in the regression model (F(3,49) = 2.869; R of 0.149; p = 0.046*). Using random forests with more variables, cognitive outcome could also be predicted (average root mean squared error between predicted and true cognitive change 11.28 ± 9.51, p = 0.039*). Also in this model, NBM volume was the most predictive variable.
NBM volume can be used as a simple non-invasive predictor for cognitive outcome after DBS in Parkinson's disease, especially when combined with other clinical parameters that are prognostically relevant.
在少数帕金森病病例中，丘脑底核深部脑刺激（DBS）与认知功能下降有关。Meynert基底核（NBM）体积减小似乎先于帕金森病的认知障碍出现。在这项回顾性研究中，我们评估了NBM体积作为丘脑底核DBS术后1年认知结果预测指标的情况。
使用基于体素的形态测量法从术前磁共振成像（MRI）计算NBM体积。认知结果定义为简易精神状态检查表（MMSE）或德语简短智能测试（DemTect）评分从术前到术后1年的相对变化。对术前神经心理学测试中受影响的认知领域数量和统一帕金森病评定量表第三部分（UPDRS III）进行了多元线性回归分析。为了考虑其他变量和潜在的非线性效应，还应用了基于随机森林的额外机器学习分析。
纳入了55例在我们中心接受双侧丘脑底核DBS电极植入的帕金森病患者（39例男性，年龄61.4±7.5岁，病程10.8±4.7年）。虽然总体认知功能没有显著变化，但个体认知能力的变化是可变的。在回归模型（F(3,49)=2.869；R为0.149；p=0.046*）中，基于NBM大小可以预测认知结果（B=208.98，p=0.022*）。使用包含更多变量的随机森林，也可以预测认知结果（预测和真实认知变化之间的平均均方根误差为11.28±9.51，p=0.039*）。在这个模型中也是如此，NBM体积是最具预测性的变量。
NBM体积可作为帕金森病DBS术后认知结果的简单非侵入性预测指标，特别是与其他具有预后相关性的临床参数相结合时。
