Decline in drawing ability and cerebral perfusion in Parkinson's disease patients after subthalamic nucleus deep brain stimulation surgery. (January 2020)

• Record Type: Journal Article
• Authors: Furukawa, Shogo; Hirano, Shigeki; Yamamoto, Tatsuya; Asahina, Masato; Uchiyama, Tomoyuki; Yamanaka, Yoshitaka; Nakano, Yoshikazu; Ishikawa, Ai; Kojima, Kazuho; Abe, Midori; Uji, Yuriko; Higuchi, Yoshinori; Horikoshi, Takuro; Uno, Takashi; Kuwabara, Satoshi
• Is Part Of: Parkinsonism & related disorders. Volume 70(2020)
• Page Start: 60
• Page End: 66
• Publication Date: 2020-01
• Subjects: Drawing ability -- Parkinson's disease -- Deep brain stimulation -- Cingulate cortex -- Cerebral blood flow; BA Brodmann's area -- rCBF regional cerebral blood flow -- DBS deep brain stimulation -- FAB Frontal Assessment Battery -- LEDD levodop equivalent daily dose -- MMSE Mini-mental state examination -- PD Parkinson's disease -- R-ANOVA repeated measures analyses of variance -- SPECT Single-photon emission computed tomography -- SPM Statistical Parametric Mapping -- STN subthalamic nucleus -- UPDRS Unified Parkinson's Disease Rating Scale -- WAB Western Aphasia Battery; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2019.12.002
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Background: Subthalamic nucleus deep brain stimulation (STN DBS) is an established therapy for alleviating motor symptoms in advanced Parkinson's disease (PD) patients; however, a postoperative decline in cognitive and speech function has become problematic although its mechanism remains unclear. The aim of the present study was to elucidate the properties of language and drawing ability and cerebral perfusion in PD patients after bilateral STN DBS surgery. Methods: Western aphasia battery, including drawing as a subcategory, and perfusion ( N -isopropyl-p-[ 123 I] iodoamphetamine) SPECT scan was conducted in 21 consecutive PD patients, before, and three to six months after, bilateral STN DBS surgery while on stimulation. Perfusion images were compared with those of 17 age- and gender-matched healthy volunteers. In the parametric image analysis, the statistical peak threshold was set at P < 0.001 uncorrected with a cluster threshold set at P < 0.05 uncorrected. Results: Although motor symptoms were improved and general cognition was preserved in the patient group, 11 patients (52.4%) showed a decline in the drawing subcategory after surgery, which showed a reduction in Frontal Assessment Battery score in this group of patients. Statistical parametric analysis of the brain perfusion images showed a decrease of cerebral blood flow in the prefrontal and cingulate cortex after surgery. Patients whose drawing ability declined showed decreased perfusion in the middle cingulate cortex comparing before and after surgery. Conclusion: Present results show that some PD patients show a decline in drawing ability after bilateral STN DBS which may attributable by dysfunction in the cingulate network. Highlights: Subthalamic nucleus deep brain stimulation (STN DBS) was conducted in 21 Parkinson's disease (PD). Western aphasia battery and perfusion image was performed before and after surgery. STN DBS affects drawing ability 3 to 6 months after surgery in 52% of PD patients. PD with drawing disability showed decreased perfusion in middle cingulate cortex. Drawing disability may result from frontal, visuospatial, and executive dysfunction.