Category: Neurodegenerative Disease (e.g. MS, Parkinson's disease); Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); International
To examine the cognitive and emotional effects of Subthalamic Nucleus (STN)-Deep Brain Stimulation (DBS) and Globus Palidus internal (GPi)-DBS. Parkinson's disease (PD) is a progressive movement disorder that is mainly managed by pharmacotherapy and is accompanied by a cognitive decline. In recent years, DBS of the STN or the GPi, which are parts of the basal ganglia, is considered an effective treatment for the motor symptoms of patients with advanced PD. However, findings concerning the cognitive effects of DBS are inconsistent.
Design : A before-after DBS neuropsychological evaluation
An ambulatory neuropsychiatric clinic in Hadassah Medical Center, Jerusalem, Israel.
Participants (or Animals, Specimens, Cadavers) :
39 patients who underwent DBS surgery for PD and a pre-operation neuropsychological assessment were approached for a post surgery evaluation. 19 did not consent. Twenty-five patients therefore were evaluated before and after DBS surgery. 16 males, aged 47-80 years. Eighteen patients underwent STN-DBS, and seven patients underwent GPi-DBS. Evaluation included Neuropsychological, Depression and Quality of life assessments.
Interventions : Using cognitive evaluation measurements, cognitive evaluation was conducted on a range of one to seven months pre-DBS, and five to 29 months post-DBS
Main Outcome Measure(s) : neuropsychological assessment including Addenbrooke's cognitive evaluation, Frontal assessment battery, Beck depression inventory and Parkinson's desease quality of life questionnaire.
Results : A decline of general cognitive functioning, language, visuospatial, orientation, and verbal fluency was detected following DBS. Regardless of DBS location, older participants showed a greater decline in verbal fluency abilities. GPi-DBS led to a greater cognitive decline than STN-DBS in general cognitive functioning, MMSE and memory. Associations were found between BDI and QoL and cognitive decline.
Our findings demonstrated a decline in cognitive functioning following DBS. However, STN-DBS seems to be associated with better cognitive outcomes.
Shiri Ben Naim– Hadassah Hebrew University Medical Center, Jerusalem, Academic College Tel Aviv, Ramat Raziel, Yerushalayim
Chen Daudi– intern in rehabilitation psychology, neuropsychiatric clinic, Hadassah Hebrew University Medical Center Jerusalem, Academic College Tel Aviv, Jerusalem, Yerushalayim
Gilad Gal– senior lecturer, Academic College Tel Aviv, Jerusalem, Yerushalayim
Yasmin Abo Foul– Neuropsychiatry clinic, Hadassah Hebrew University Medical Center, Jerusalem, Jerusalem, Yerushalayim
Or Peled– intern in rehabilitation psychology, neuropsychiatry clinic, Hadassah Hebrew University Medical Center, Jerusalem, Jerusalem, Yerushalayim
Zvi Israel– Head of DBS unit, Hadassah Hebrew University Medical Center, Jerusalem, Jerusalem, Yerushalayim
Eddie Linetzky– neurologist, Hadassah Hebrew University Medical Center, Jerusalem, Jerusalem, Yerushalayim
David Arkadir– neurologist, Hadassah Hebrew University Medical Center, Jerusalem, Jerusalem, Yerushalayim
Renana Eitan– Psychiatrist, Jerusalem Mental Health Center, Hebrew University Medical Center, Jerusalem;, Brigham and Women, Jerusalem, Yerushalayim