Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic; Department of Cybernetics, Czech Technical University in Prague, Prague, Czech Republic; Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, USA.
Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czech Republic.
Neuroimage Clin. 2024;42:103617. doi: 10.1016/j.nicl.2024.103617. Epub 2024 May 8.
The intricate relationship between deep brain stimulation (DBS) in Parkinson's disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients.
Pre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and follow-up for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population - Dementia Rating Scale 2.
PD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups.
Our findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.
深部脑刺激（DBS）在帕金森病（PD）中的应用与认知障碍之间的复杂关系近来引起了广泛关注。本研究旨在评估 PD-DBS 患者术前的大脑结构和微观结构模式是否可作为未来认知能力下降的预测指标。
将 72 例 PD 患者的术前 MRI 数据与神经心理学检查和平均 2.3 年后的 DBS 植入后随访结果相结合，采用在捷克人群中用于 PD 轻度认知障碍诊断的经过验证的筛查认知测试——Dementia Rating Scale 2 进行评估。
研究发现，术后认知能力下降的 PD 患者在术前阶段的皮质厚度和微观结构复杂性明显低于认知稳定的 PD 患者。在与认知直接相关的区域（双侧顶叶、岛叶和扣带回皮质），以及枕叶和感觉运动皮质，均检测到了差异。此外，还涉及到海马体、壳核、小脑和上脑干，尽管两组患者在术前认知表现和 DBS 靶点位置或刺激参数方面无差异。
我们的研究结果表明，在本研究中，PD 患者的认知能力下降并非主要归因于丘脑底核的 DBS，而是与 DBS 系统植入前就存在的、对未来认知恶化的临床无症状的结构和微观结构易感性有关。
