帕金森病单侧丘脑底核深部脑刺激的认知差异效应
Differential Cognitive Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson's 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, Cutter Gary, Hurt Chris P, Wade Melissa, Robinson Frank G, 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, Alabama, USA.
The Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
出版信息
Ann Neurol. 2024 Jun;95(6):1205-1219. doi: 10.1002/ana.26903. Epub 2024 Mar 19.
OBJECTIVE
The aim of this study was to investigate the cognitive effects of unilateral directional versus ring subthalamic nucleus deep brain stimulation (STN DBS) in patients with advanced Parkinson's disease.
METHODS
We examined 31 participants who underwent unilateral STN DBS (left n = 17; right n = 14) as part of an National Institutes of Health (NIH)-sponsored randomized, double-blind, crossover study contrasting directional versus ring stimulation. All participants received unilateral DBS implants in the hemisphere more severely affected by motor parkinsonism. Measures of cognition included verbal fluency, auditory-verbal memory, and response inhibition. We used mixed linear models to contrast the effects of directional versus ring stimulation and implant hemisphere on longitudinal cognitive function.
RESULTS
Crossover analyses showed no evidence for group-level changes in cognitive performance related to directional versus ring stimulation. Implant hemisphere, however, impacted cognition in several ways. Left STN participants had lower baseline verbal fluency than patients with right implants (t [20.66 = -2.50, p = 0.02]). Verbal fluency declined after left (p = 0.013) but increased after right STN DBS (p < 0.001), and response inhibition was faster following right STN DBS (p = 0.031). Regardless of hemisphere, delayed recall declined modestly over time versus baseline (p = 0.001), and immediate recall was unchanged.
INTERPRETATION
Directional versus ring STN DBS did not differentially affect cognition. Similar to prior bilateral DBS studies, unilateral left stimulation worsened verbal fluency performance. In contrast, unilateral right STN surgery increased performance on verbal fluency and response inhibition tasks. Our findings raise the hypothesis that unilateral right STN DBS in selected patients with predominant right brain motor parkinsonism could mitigate declines in verbal fluency associated with the bilateral intervention. ANN NEUROL 2024;95:1205-1219.
目的
本研究旨在调查单侧定向与环状丘脑底核深部脑刺激（STN DBS）对晚期帕金森病患者认知功能的影响。
方法
我们检查了31名接受单侧STN DBS的参与者（左侧n = 17；右侧n = 14），这是一项由美国国立卫生研究院（NIH）资助的随机、双盲、交叉研究的一部分，该研究对比了定向刺激与环状刺激。所有参与者均在运动性帕金森病影响更严重的半球接受单侧DBS植入。认知测量包括言语流畅性、听觉言语记忆和反应抑制。我们使用混合线性模型来对比定向刺激与环状刺激以及植入半球对纵向认知功能的影响。
结果
交叉分析显示，没有证据表明与定向刺激和环状刺激相关的认知表现存在组水平变化。然而，植入半球在几个方面影响了认知。左侧STN参与者的基线言语流畅性低于右侧植入患者（t[20.66 = -2.50，p = 0.02]）。左侧STN DBS后言语流畅性下降（p = 0.013），而右侧STN DBS后言语流畅性增加（p < 0.001），并且右侧STN DBS后反应抑制更快（p = 0.031）。无论半球如何，与基线相比，延迟回忆随时间适度下降（p = 0.001），而即时回忆没有变化。
解读
定向与环状STN DBS对认知的影响没有差异。与先前的双侧DBS研究类似，单侧左侧刺激会使言语流畅性表现恶化。相比之下，单侧右侧STN手术提高了言语流畅性和反应抑制任务的表现。我们的研究结果提出了一个假设，即在某些以右脑运动性帕金森病为主的患者中，单侧右侧STN DBS可以减轻与双侧干预相关的言语流畅性下降。《神经病学年鉴》2024；95：1205 - 1219。
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