Neuropsychological changes following deep brain stimulation surgery for Parkinson's disease: comparisons of treatment at pallidal and subthalamic targets versus best medical therapy. Issue 6 (2nd September 2014)

• Record Type: Journal Article
• Authors: Rothlind, Johannes C; York, Michele K; Carlson, Kim; Luo, Ping; Marks, William J; Weaver, Frances M; Stern, Matthew; Follett, Kenneth; Reda, Domenic
• Other Names: Ippolito Dolores author non-byline.; Stoner Gatana author non-byline.; Barnett Tammy author non-byline.; Bukowski Ken author non-byline.; DeNicolo Rosemarie author non-byline.; Hur Kwan author non-byline.; Jimenez Joyce author non-byline.; Motyka Jan author non-byline.; Simon Theresa author non-byline.; Thakkar Bharat author non-byline.; Woolson Robert author non-byline.; Fye Carol author non-byline.; Gagne William author non-byline.; Harris Crystal author non-byline.; Heemskerk Jill author non-byline.; Moy Claudia author non-byline.; Sheehy Paul author non-byline.; O'Leary Timothy author non-byline.; Huang Grant D author non-byline.; Fiore Louis author non-byline.; Hall Robert author non-byline.; Stroupe Kevin author non-byline.; Burchiel Kim author non-byline.; Fye Carol author non-byline.; Harris Crystal author non-byline.; Heemskerk Jill author non-byline.; Hur Kwan author non-byline.; Koller William author non-byline.; Moy Claudia author non-byline.; Pahwa Rajesh author non-byline.; Sagher Oren author non-byline.; Sheehy Paul author non-byline.; Bakay Roy author non-byline.; Chappell Rick author non-byline.; Hart Robert author non-byline.; Holloway Robert author non-byline.; McCabe George author non-byline.; Schenkman Margaret author non-byline.; Taha Jamal author non-byline.; Buckelew Julia author non-byline.; Fye Carol author non-byline.; Garin Marilyn author non-byline.; Matzek Sharon author non-byline.; Smith Donna author non-byline.; Bronstein Jeff author non-byline.; Duda John author non-byline.; Hogarth Penelope author non-byline.; Holloway Kathryn author non-byline.; Horn Stacy author non-byline.; Lai Eugene C author non-byline.; Samii Ali author non-byline.; Atassi Farah author non-byline.; Bello Cecilia author non-byline.; Bunting-Perry Lisette author non-byline.; Conn Tina author non-byline.; Cugley Alice author non-byline.; Eubank Nanette author non-byline.; Fincher Linda author non-byline.; Franks Romay author non-byline.; Harris Tammy author non-byline.; Haselman Mariann author non-byline.; Heath Susan author non-byline.; Hirsch Miriam author non-byline.; Janovsky Virginia author non-byline.; Lanier Elaine author non-byline.; Lloyd Mary author non-byline.; Loehner Susan author non-byline.; O'Connor Susan author non-byline.; Ordonez Ligaya author non-byline.; Maccarone Heather author non-byline.; Massey-Makhoul Kelli author non-byline.; Matthews Mary author non-byline.; Meyn Elizabeth author non-byline.; Mimura Keiko author non-byline.; Morrow Wes author non-byline.; Searles Tammy author non-byline.; Valotta Jamye author non-byline.; Vasthare Usha author non-byline.; Volz Monica author non-byline.; Ward Constance author non-byline.; Warker Rebecca author non-byline.; Watson Heidi author non-byline.; Willson Pamela author non-byline.; Baron Mark author non-byline.; Brodsky Matthew author non-byline.; Calabrese Vincent author non-byline.; Campbell Gordon author non-byline.; Colcher Amy author non-byline.; Farag Emad author non-byline.; Henry Eva author non-byline.; Hou Jyh-Gong author non-byline.; Kang Gail author non-byline.; Kleiner-Fisman Galit author non-byline.; Kraakevik Jeff author non-byline.; Nutt John author non-byline.; Ostrem Jill author non-byline.; Sarwar Aliya author non-byline.; Subramanian Indu author non-byline.; Vanek Zeba author non-byline.; Baltuch Gordon author non-byline.; Burchiel Kim author non-byline.; De Salles Antonio author non-byline.; Eller Jorge author non-byline.; Holloway Kathryn author non-byline.; Larson Paul author non-byline.; Simpson Richard author non-byline.; Starr Philip author non-byline.; Carne William author non-byline.; Erikson Tom author non-byline.; Kreutzer Jeffrey author non-byline.; Mendez Mario author non-byline.; Moberg Paul author non-byline.; Ragland John author non-byline.; Seel Ronald author non-byline.; Soety Elizabeth author non-byline.; Storzbach Daniel author non-byline.; Troster Alexander author non-byline.; Jaggi Jurg author non-byline.;
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 86:Issue 6(2015)
• Page Start: 622
• Page End: 629
• Publication Date: 2014-09-02
• Subjects: ELECTRICAL STIMULATION -- MOVEMENT DISORDERS -- NEUROPSYCHOLOGY -- NEUROSURGERY -- PARKINSON'S DISEASE; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2014-308119
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Deep brain stimulation (DBS) improves motor symptoms in Parkinson's disease (PD), but questions remain regarding neuropsychological decrements sometimes associated with this treatment, including rates of statistically and clinically meaningful change, and whether there are differences in outcome related to surgical target. Methods: Neuropsychological functioning was assessed in patients with Parkinson's disease (PD) at baseline and after 6 months in a prospective, randomised, controlled study comparing best medical therapy (BMT, n=116) and bilateral deep brain stimulation (DBS, n=164) at either the subthalamic nucleus (STN, n=84) or globus pallidus interna (GPi, n=80), using standardised neuropsychological tests. Measures of functional outcomes were also administered. Results: Comparison of the two DBS targets revealed few significant group differences. STN DBS was associated with greater mean reductions on some measures of processing speed, only one of which was statistically significant in comparison with stimulation of GPi. GPi DBS was associated with lower mean performance on one measure of learning and memory that requires mental control and cognitive flexibility. Compared to the group receiving BMT, the combined DBS group had significantly greater mean reductions at 6-month follow-up in performance on multiple measures of processing speed and working memory. After calculating thresholds for statistically reliable change from data obtained from the BMT group, the combined DBS group also displayed higher rates of decline in neuropsychological test performance. Among study completers, 18 (11%) study participants receiving DBS displayed reliable decline by multiple indicators in two or more cognitive domains, a significantly higher rate than in the BMT group (3%). This multi-domain cognitive decline was associated with less beneficial change in subjective ratings of everyday functioning and quality of life (QOL). The multi-domain cognitive decline group continued to function at a lower level at 24-month follow-up. Conclusions: In those with PD, the likelihood of significant decline in neuropsychological functioning increases with DBS, affecting a small minority of patients who also appear to respond less optimally to DBS by other indicators of QOL. Trial registration number: NCT00056563 and NCT01076452 .