Bucur Madalina, Papagno Costanza
Center for Mind/Brain Sciences (CIMeC), University of Trento, Trento, Italy.
Neuropsychol Rev. 2023 Jun;33(2):307-346. doi: 10.1007/s11065-022-09540-9. Epub 2022 Mar 23.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidum internus (GPi) improves motor functions in patients with Parkinson's disease (PD) but may cause a decline in specific cognitive domains. The aim of this systematic review and meta-analysis was to assess the long-term (1-3 years) effects of STN or GPi DBS on four cognitive functions: (i) memory (delayed recall, working memory, immediate recall), (ii) executive functions including inhibition control (Color-Word Stroop test) and flexibility (phonemic verbal fluency), (iii) language (semantic verbal fluency), and (iv) mood (anxiety and depression). Medline and Web of Science were searched, and studies published before July 2021 investigating long-term changes in PD patients following DBS were included. Random-effects model meta-analyses were performed using the R software to estimate the standardized mean difference (SMD) computed as Hedges' g with 95% CI. 2522 publications were identified, 48 of which satisfied the inclusion criteria. Fourteen meta-analyses were performed including 2039 adults with a clinical diagnosis of PD undergoing DBS surgery and 271 PD controls. Our findings add new information to the existing literature by demonstrating that, at a long follow-up interval (1-3 years), both positive effects, such as a mild improvement in anxiety and depression (STN, Hedges' g = 0,34, p = 0,02), and negative effects, such as a decrease of long-term memory (Hedges' g = -0,40, p = 0,02), verbal fluency such as phonemic fluency (Hedges' g = -0,56, p < 0,0001), and specific subdomains of executive functions such as Color-Word Stroop test (Hedges' g = -0,45, p = 0,003) were observed. The level of evidence as qualified with GRADE varied from low for the pre- verses post-analysis to medium when compared to a control group.
对丘脑底核(STN)或苍白球内侧部(GPi)进行深部脑刺激(DBS)可改善帕金森病(PD)患者的运动功能,但可能导致特定认知领域的衰退。本系统评价和荟萃分析的目的是评估STN或GPi DBS对四种认知功能的长期(1至3年)影响:(i)记忆(延迟回忆、工作记忆、即时回忆),(ii)执行功能,包括抑制控制(颜色-词语斯特鲁普测验)和灵活性(音素流畅性),(iii)语言(语义流畅性),以及(iv)情绪(焦虑和抑郁)。检索了Medline和科学网,并纳入了2021年7月之前发表的研究DBS后PD患者长期变化的研究。使用R软件进行随机效应模型荟萃分析,以估计以Hedges' g计算并带有95%置信区间的标准化均数差(SMD)。共识别出2522篇出版物,其中48篇符合纳入标准。进行了14项荟萃分析,包括2039例临床诊断为PD且接受DBS手术的成年人以及271例PD对照组。我们的研究结果为现有文献增添了新信息,表明在较长的随访期(1至3年),既观察到了积极影响,如焦虑和抑郁有轻度改善(STN,Hedges' g = 0.34,p = 0.02),也观察到了消极影响,如长期记忆下降(Hedges' g = -0.40,p = 0.02)、音素流畅性等言语流畅性下降(Hedges' g = -0.56,p < 0.0001)以及颜色-词语斯特鲁普测验等执行功能的特定子领域下降(Hedges' g = -0.45,p = 0.003)。GRADE评定的证据水平从分析前与分析后的低水平到与对照组比较时的中等水平不等。
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