Risk factors for executive dysfunction after subthalamic nucleus stimulation in Parkinson's disease |
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| Authors: | Christine Daniels MD Paul Krack MD PhD Jens Volkmann MD PhD Markus O. Pinsker MD PhD Martin Krause MD PhD Volker Tronnier MD PhD Manja Kloss MD Alfons Schnitzler MD PhD Lars Wojtecki MD Kai Bötzel MD PhD Adrian Danek MD PhD Rüdiger Hilker MD PhD Volker Sturm MD PhD Andreas Kupsch MD PhD Elfriede Karner MPsych Günther Deuschl MD PhD Karsten Witt MD PhD |
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| Affiliation: | 1. Department of Neurology, Christian‐Albrechts‐University, Kiel, Germany;2. Potential conflict of interest: Drs. B?tzel, Deuschl, Krack, Krause, Kupsch, Pinsker, Schnitzler, Sturm, Tronnier, Volkmann, and Wojtecki report having received speaking fees from Medtronic;3. Drs. Deuschl, Tronnier, Volkmann, and Wojtecki report having received consulting fees from Medtronic;4. Drs. Deuschl, Kupsch, Krause, Krack, and Volkmann report having received research grants from Medtronic;5. and Dr. Sturm reports owning stock options from Medtronic. No other potential conflict of interest relevant to this article was reported.;6. Department of Neurosurgery, Christian‐Albrechts‐University, Kiel, Germany;7. Department of Neurology, Heidelberg University, Heidelberg, Germany;8. Department of Neurosurgery, Heidelberg University, Heidelberg, Germany;9. Department of Neurology, Heinrich Heine University, Dusseldorf, Germany;10. Department of Neurology, Ludwig‐Maximilians‐University, Munich, Germany;11. Department of Neurology, Cologne University, Cologne, Germany;12. Department of Neurosurgery, Cologne University, Cologne, Germany;13. Department of Neurology, Charité Hospital, Humboldt University, Berlin, Germany;14. Department of Neurology, Innsbruck Medical University, Innsbruck, Austria |
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| Abstract: | ![]()
A slight decline in cognitive functions and especially in executive functioning after deep brain stimulation (DBS) of the nucleus subthalamicus (STN) in patients with Parkinson's disease (PD) has been described. This study evaluated baseline parameters that contribute to a deterioration of cognitive functioning after DBS. We analyzed data from the neuropsychological protocol in a randomized controlled study comparing DBS with best medical treatment (BMT). Change scores were calculated for the cognitive domains “global cognitive functioning,” “memory,” “working memory,” “attention,” and “executive function.” These domain‐specific change scores were correlated with previously defined preoperative parameters. Compared with the BMT group (63 patients), the STN‐DBS group (60 patients) showed a significant decline only in the domain executive function 6 months after DBS, which was significantly correlated with age, levodopa‐equivalence dosage (LED) and axial subscore of the UPDRS in the off‐medication state at baseline. Multiple regression analysis showed that these three factors explained, however, only about 23% of the variance. Patients with higher age, higher baseline LED, and/or higher axial subscore of the UPDRS at baseline have an increased risk for worsening of executive function after STN‐DBS. High scores of these factors might reflect an advanced stage of disease progression. As these baseline factors explained the variance of the change score executive function only to a minor proportion, other factors including the surgical procedure, the exact placement of the electrode or postsurgical management might be more relevant for a decline in executive functioning after STN‐DBS. © 2010 Movement Disorder Society |
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| Keywords: | Parkinson's disease deep brain stimulation subthalamic nucleus executive functions verbal fluency |
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