Cognitive effects of subthalamic nucleus deep brain stimulation in Parkinson's disease.
Item
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Title
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Cognitive effects of subthalamic nucleus deep brain stimulation in Parkinson's disease.
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Identifier
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AAI9997114
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identifier
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9997114
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Creator
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Morrison, Christina E.
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Contributor
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Adviser: Joan C. Borod
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Date
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2001
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Language
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English
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Publisher
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City University of New York.
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Subject
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Biology, Neuroscience
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Abstract
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The cognitive effects of subthalamic nucleus (STN) stimulation have been investigated, however, there are no reported studies that evaluate, by incorporating a demographically and clinically matched disease control group, whether neuropsychological performance in surgical patients changes beyond the variability of the assessment measures. To address this issue, 17 Parkinson's disease (PD) patients (DBSPD) were tested before and 3.3 months (on average) after bilateral STN stimulator implantation, both on and off stimulation. Eleven demographically and clinically matched PD controls (CPD) were administered the same repeatable neuropsychological test battery twice (Morrison et al, 2000), separated by 2.4 months, with no surgical intervention during the interval. The standardized test scores were grouped by cognitive domain (i.e., Attention, Language, Visuospatial, Verbal Learning, Delayed Recall, Recognition Memory, and Executive), and composite scores for each domain were calculated. Depression was also evaluated. The primary analyses included two-way mixed MANOVAs (2 x 2) for the composite scores and for the variables within each cognitive domain to evaluate the individual effects of electrode implantation (Surgery Comparison), high frequency STN stimulation (Stimulation Comparison), and the overall effects of the DBS procedure (Procedure Comparison). Secondary analyses evaluated the univariate Subject Group by Condition interaction for each variable in each comparison.;Relative to change seen in the control group across conditions, the surgery for bilateral electrode implantation adversely affected attention and concentration, and tended to negatively affect verbal learning, naming, and verbal fluency. STN stimulation had little effect on cognition, although there was the suggestion that it may have improved attention somewhat. The STN DBS procedure as a whole tended to result in mild decline in mental tracking, verbal learning, delayed verbal recall, and verbal fluency. Overall, there were no surgery, stimulation, or procedure effects on the depression scale scores. In contrast to these group findings, one DBS patient demonstrated significant cognitive decline following surgery such that he was not testable with stimulation-off but was able to complete most of the battery with stimulation-on. In conclusion, although most subjects experienced only minimal cognitive declines in isolated aspects of cognitive functioning following the STN DBS procedure, on rare occasions, some patients may develop more significant impairment.
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Type
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dissertation
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Source
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PQT Legacy CUNY.xlsx
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degree
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Ph.D.
