帕金森病患者单侧左、右丘脑底核深部脑刺激的认知差异效应
Differential cognitive effects of unilateral left and right subthalamic nucleus deep brain stimulation for Parkinson disease.
作者信息
Del Bene Victor A, Martin Roy C, Brinkerhoff Sarah A, Olson Joseph W, Nelson Matthew J, Marotta Dario, Gonzalez Christopher L, Mills Kelly A, Kamath Vidyulata, Bentley J Nicole, Guthrie Barton L, Knight Robert T, Walker Harrison C
机构信息
Department of Neurology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
出版信息
medRxiv. 2023 Mar 1:2023.02.27.23286478. doi: 10.1101/2023.02.27.23286478.
OBJECTIVE
To investigate hemispheric effects of directional versus ring subthalamic nucleus (STN) deep brain stimulation (DBS) surgery on cognitive function in patients with advanced Parkinson's disease (PD).
METHODS
We examined 31 PD patients (Left STN n = 17; Right STN n = 14) who underwent unilateral subthalamic nucleus (STN) DBS as part of a NIH-sponsored randomized, cross-over, double-blind (ring vs directional) clinical trial. Outcome measures were tests of verbal fluency, auditory-verbal memory, and response inhibition. First, all participants were pooled together to study the effects of directional versus ring stimulation. Then, we stratified the groups by surgery hemisphere and studied the longitudinal changes in cognition post-unilateral STN DBS.
RESULTS
Relative to pre-DBS cognitive baseline performances, there were no group changes in cognition following unilateral DBS for either directional or ring stimulation. However, assessment of unilateral DBS by hemisphere revealed a different pattern. The left STN DBS group had lower verbal fluency than the right STN group ((20.66 = -2.50, = 0.02). Over a period of eight months post-DBS, verbal fluency declined in the left STN DBS group ( = 0.013) and improved in the right STN DBS group over time ( < .001). Similarly, response inhibition improved following right STN DBS ( = 0.031). Immediate recall did not significantly differ over time, nor was it affected by implant hemisphere, but delayed recall equivalently declined over time for both left and right STN DBS groups (left STN DBS = 0.001, right STN DBS differ from left STN DBS = 0.794).
CONCLUSIONS
Directional and ring DBS did not differentially or adversely affect cognition over time. Regarding hemisphere effects, verbal fluency decline was observed in those who received left STN DBS, along with the left and right STN DBS declines in delayed memory. The left STN DBS verbal fluency decrement is consistent with prior bilateral DBS research, likely reflecting disruption of the basal-ganglia-thalamocortical network connecting STN and inferior frontal gyrus. Interestingly, we found an improvement in verbal fluency and response inhibition following right STN DBS. It is possible that unilateral STN DBS, particularly in the right hemisphere, may mitigate cognitive decline.
目的
研究丘脑底核（STN）定向与环状深部脑刺激（DBS）手术对晚期帕金森病（PD）患者认知功能的半球效应。
方法
我们检查了31例接受单侧丘脑底核（STN）DBS手术的PD患者（左侧STN n = 17；右侧STN n = 14），该手术是美国国立卫生研究院资助的一项随机、交叉、双盲（环状与定向）临床试验的一部分。结果测量指标包括语言流畅性、听觉言语记忆和反应抑制测试。首先，将所有参与者合并在一起，研究定向刺激与环状刺激的效果。然后，我们按手术半球对组进行分层，并研究单侧STN DBS术后认知功能的纵向变化。
结果
相对于DBS术前的认知基线表现，单侧DBS术后，无论是定向刺激还是环状刺激，认知功能均无组间变化。然而，按半球评估单侧DBS时发现了不同的模式。左侧STN DBS组的语言流畅性低于右侧STN组（（20.66 = -2.50， = 0.02）。在DBS术后8个月期间，左侧STN DBS组的语言流畅性下降（ = 0.013），而右侧STN DBS组的语言流畅性随时间改善（ <.001）。同样，右侧STN DBS术后反应抑制能力提高（ = 0.031）。即时回忆随时间无显著差异，也不受植入半球的影响，但左侧和右侧STN DBS组的延迟回忆均随时间等效下降（左侧STN DBS = 0.001，右侧STN DBS与左侧STN DBS的差异 = 0.794）。
结论
随着时间的推移，定向和环状DBS对认知功能没有差异或不利影响。关于半球效应，接受左侧STN DBS者出现语言流畅性下降，同时左侧和右侧STN DBS患者的延迟记忆均下降。左侧STN DBS导致的语言流畅性下降与先前的双侧DBS研究一致，可能反映了连接STN和额下回的基底神经节 - 丘脑皮质网络的破坏。有趣的是，我们发现右侧STN DBS术后语言流畅性和反应抑制能力有所改善。单侧STN DBS，特别是在右侧半球，可能减轻认知功能下降。
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