Cognitive outcome and reliable change indices two years following bilateral subthalamic nucleus deep brain stimulation.

Subthalamic nucleus deep brain stimulation (STN-DBS) is currently the treatment of choice for medication-resistant levodopa-related motor complications in patients with Parkinson’s disease (PD). While STN-DBS often results in meaningful motor improvements, consensus regarding long-term neuropsychological outcome continues to be debated. We assessed the cognitive outcomes of 19 STN-DBS patients compared to a group of 18 medically-managed PD patients on a comprehensive neuropsychological battery at baseline and two years post-surgery. Patients did not demonstrate changes in global cognitive functioning on screening measures. However, neuropsychological results revealed impairments in nonverbal recall, oral information processing speed, and lexical and semantic fluency in STN-DBS patients compared to PD controls 2 years post-surgery in these preliminary analyses. Additionally, reliable change indices revealed that approximately 50% of STN-DBS patients demonstrated significant declines in nonverbal memory and oral information processing speed compared to 25% to 30% of PD controls, and 26% of STN-DBS patients declined on lexical fluency compared to 11% of PD patients. Approximately 30% of both groups declined on semantic fluency. The number of STN-DBS patients who converted to dementia 2 years following surgery was not significantly different from the PD participants (32% versus 16%, respectively). Our results suggest that neuropsychological evaluations may identify possible mild cognitive changes following surgery.

丘脑底核深部脑刺激（STN - DBS）目前是帕金森病（PD）患者中对药物抵抗的左旋多巴相关运动并发症的首选治疗方法。虽然STN - DBS通常会带来有意义的运动改善，但关于长期神经心理学结果的共识仍存在争议。我们对19名接受STN - DBS治疗的患者和18名接受药物治疗的PD患者进行了评估，在基线和术后两年使用一套综合神经心理学测试来检测认知结果。患者在筛选测试中未显示出整体认知功能的变化。然而，神经心理学结果显示，在这些初步分析中，与PD对照组相比，术后2年STN - DBS患者在非言语回忆、口头信息处理速度以及词汇和语义流畅性方面存在损伤。此外，可靠变化指数显示，与25% - 30%的PD对照组相比，约50%的STN - DBS患者在非言语记忆和口头信息处理速度方面出现显著下降，与11%的PD患者相比，26%的STN - DBS患者在词汇流畅性方面下降。两组中约30%在语义流畅性方面下降。术后2年转变为痴呆的STN - DBS患者数量与PD参与者相比无显著差异（分别为32%和16%）。我们的结果表明，神经心理学评估可能会发现手术后可能出现的轻度认知变化。