Rački Valentino, Hero Mario, Rožmarić Gloria, Papić Eliša, Raguž Marina, Chudy Darko, Vuletić Vladimira
Department of Neurology, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
Clinic of Neurology, Clinical Hospital Center Rijeka, Rijeka, Croatia.
Front Hum Neurosci. 2022 May 13;16:867055. doi: 10.3389/fnhum.2022.867055. eCollection 2022.
Parkinson's disease (PD) patients have a significantly higher risk of developing dementia in later disease stages, leading to severe impairments in quality of life and self-functioning. Questions remain on how deep brain stimulation (DBS) affects cognition, and whether we can individualize therapy and reduce the risk for adverse cognitive effects. Our aim in this systematic review is to assess the current knowledge in the field and determine if the findings could influence clinical practice.
We have conducted a systematic review according to PRISMA guidelines through MEDLINE and Embase databases, with studies being selected for inclusion a set inclusion and exclusion criteria.
Sixty-seven studies were included in this systematic review according to the selected criteria. This includes 6 meta-analyses, 18 randomized controlled trials, 17 controlled clinical trials, and 26 observational studies with no control arms. The total number of PD patients encompassed in the studies cited in this review is 3677, not including the meta-analyses.
Cognitive function in PD patients can deteriorate, in most cases mildly, but still impactful to the quality of life. The strongest evidence is present for deterioration in verbal fluency, while inconclusive evidence is still present for executive function, memory, attention and processing speed. Global cognition does not appear to be significantly impacted by DBS, especially if cognitive screening is performed prior to the procedure, as lower baseline cognitive function is connected to poor outcomes. Further randomized controlled studies are required to increase the level of evidence, especially in the case of globus pallidus internus DBS, pedunculopontine nucleus DBS, and the ventral intermediate nucleus of thalamus DBS, and more long-term studies are required for all respective targets.
帕金森病（PD）患者在疾病后期患痴呆症的风险显著更高，这会导致生活质量和自我功能严重受损。关于深部脑刺激（DBS）如何影响认知，以及我们是否可以实现个体化治疗并降低不良认知效应的风险，仍存在疑问。我们进行这项系统评价的目的是评估该领域的现有知识，并确定研究结果是否会影响临床实践。
我们根据PRISMA指南，通过MEDLINE和Embase数据库进行了一项系统评价，根据一套纳入和排除标准选择纳入研究。
根据选定标准，本系统评价纳入了67项研究。其中包括6项荟萃分析、18项随机对照试验、17项对照临床试验和26项无对照臂的观察性研究。本综述引用的研究中所涵盖的PD患者总数为3677例，不包括荟萃分析。
PD患者的认知功能可能会恶化，在大多数情况下程度较轻，但仍会影响生活质量。有最有力的证据表明语言流畅性会恶化，而关于执行功能、记忆、注意力和处理速度的证据仍不明确。DBS似乎不会对整体认知产生显著影响，尤其是如果在手术前进行认知筛查，因为较低的基线认知功能与不良预后相关。需要进一步的随机对照研究来提高证据水平，特别是对于内侧苍白球DBS、脚桥核DBS和丘脑腹中间核DBS，并且对于所有各自的靶点都需要更多的长期研究。
