Cappon Davide, Gratwicke James, Zrinzo Ludvic, Akram Harith, Hyam Jonathan, Hariz Marwan, Limousin Patricia, Foltynie Thomas, Jahanshahi Marjan
Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology National Hospital for Neurology and Neurosurgery London United Kingdom.
Hinda and Arthur Marcus Institute for Aging Research Hebrew Senior Life Boston Massachusetts USA.
Mov Disord Clin Pract. 2022 Jul 27;9(6):765-774. doi: 10.1002/mdc3.13510. eCollection 2022 Aug.
Degeneration of the nucleus basalis of Meynert (NBM) and cortical cholinergic dysfunction are hallmarks of Parkinson's disease dementia (PDD). There is no effective therapy for PDD. Deep brain stimulation of the NBM (NBM-DBS) has been trialed as a potential treatment.
Our primary aim was to evaluate the sustained tolerability of NBM-DBS in PDD, and its impact on global cognition, behavioral symptoms, quality of life and caregiver burden and distress. Second, we aimed to determine whether baseline measures of arousal, alertness, and attention were predictive of the three year response to NBM-DBS in PDD patients.
Five of the six PDD patients who completed the baseline assessment participated in a 3 year follow up assessment. We assessed the participants after three years of NBM-DBS on the Mini Mental State Examination, Dementia Rating Scale-2, Blessed Dementia Rating Scale, Neuropsychiatric Inventory, and the SF36.
The five patients showed varying trajectories of cognitive decline, with two showing a slower progression over the three-year follow-up period. A slower progression of decline on global cognition was associated with higher baseline accuracy on the Posner covert orienting of attention test, and less daytime sleepiness.
Whether slower progression of cognitive decline in two patients was in any way related to individual variability in responsiveness to NBM-DBS requires confirmation in a larger series including an unoperated PDD control group. Higher accuracy in covertly orienting attention and better sleep quality at baseline were associated with better cognitive outcomes at 36 months assessment. These results require validation in future studies with larger samples.
梅纳特基底核（NBM）变性和皮质胆碱能功能障碍是帕金森病痴呆（PDD）的标志。目前尚无针对PDD的有效治疗方法。对NBM进行深部脑刺激（NBM-DBS）已作为一种潜在治疗方法进行了试验。
我们的主要目的是评估NBM-DBS在PDD中的持续耐受性，及其对整体认知、行为症状、生活质量以及照料者负担和痛苦的影响。其次，我们旨在确定觉醒、警觉性和注意力的基线测量是否可预测PDD患者对NBM-DBS的三年反应。
完成基线评估的6例PDD患者中有5例参与了为期3年的随访评估。在进行NBM-DBS三年后，我们使用简易精神状态检查表、痴呆评定量表-2、Blessed痴呆评定量表、神经精神科问卷和SF36对参与者进行了评估。
这5例患者表现出不同的认知衰退轨迹，其中2例在三年随访期内衰退进展较慢。整体认知衰退进展较慢与波斯纳注意力隐蔽定向测试的较高基线准确性以及较少的日间嗜睡有关。
两名患者认知衰退进展较慢是否与对NBM-DBS反应的个体差异有关，需要在包括未手术的PDD对照组的更大样本系列中进行确认。基线时注意力隐蔽定向的较高准确性和较好的睡眠质量与36个月评估时较好的认知结果相关。这些结果需要在未来更大样本的研究中进行验证。
