Article

Chronic deep brain stimulation of the subthalamic nucleus for Parkinson's disease: Effects on cognition, mood, anxiety and personality traits

Department of Neuroscience, University of Turin, Italy.
European Neurology (Impact Factor: 1.36). 02/2006; 55(3):136-44. DOI: 10.1159/000093213
Source: PubMed

ABSTRACT To evaluate modifications occurring in cognitive functions and behavioural aspects in a group of 72 consecutive patients with Parkinson's disease (PD) 15 months after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN).
72 consecutive PD patients bilaterally implanted for DBS of the STN were evaluated before and after surgery with a mean follow-up of 15 months. A neuropsychological assessment was performed to evaluate reasoning (Raven Colour Matrices), memory (Bisyllabic Word Repetition Test, Corsi's Block-Tapping Test, Paired-Associate Learning) and frontal executive functions (Trail Making Test Part B, Nelson Modified Card Sorting Test, phonemic and category verbal fluency tasks). Mood and suicidal ideation were evaluated using the Beck Depression Inventory (BDI). Anxiety was measured by means of the State-Trait Anxiety Inventory and personality traits were evaluated with the Structured Clinical Interview for the DSM-III-R Axis II Disorders (SCID-II). Assessment of thought disorders and apathy was based on subitems of the Unified Parkinson's Disease Rating Scale.
The comparisons between pre- and postoperative neuropsychological test scores showed a significant worsening only in phonemic and semantic verbal fluency tasks, while fewer errors were found in the Nelson Modified Card Sorting Test. Globally, behavioural assessment evidenced a small improvement in mood, as assessed by the BDI, in obsessive-compulsive and paranoid personality traits (SCID-II). Thought disorders worsened while suicidal ideation, anxiety and apathy showed no postoperative modifications. The analysis of individual outcomes (+/-1 SD criterion) evidenced a relevant postoperative cognitive decline in 3 patients out of 65 (4.5%). Moreover, following implantation, 1 patients exhibited psychosis (1.5%), 2 patients experienced a clinically relevant worsening of depressive symptoms (3%), 7 patients showed an increase in anxiety (12%) and 3 patients a worsening in depression and anxiety symptoms (3%). On the contrary, 12 patients (20%) showed a relevant improvement in mood and 14 patients (23%) a relevant reduction of anxiety symptoms after the surgery.
The present study confirms that STN DBS is cognitively safe since the only relevant change observed was a mild decrease in verbal fluency tasks. Globally, a small postoperative improvement was found in the BDI, and in two SCID-II subscales concerning obsessive-compulsive and paranoid personality traits, even though postoperative behavioural disturbances can occur in individual patients.

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Available from: Lorys Castelli, Aug 31, 2015
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    • "As far as depressive symptoms are concerned, our results evidenced that the pre-DBS group was more depressed than the C group, while no difference emerged between the DBS and C groups. This evidence seems to confirm the results of previous studies showing a positive effect of STN-DBS on depressive symptoms (Castelli et al., 2006), even though, as previously stated, this issue is still debated and other studies have pointed out a post-surgery increase in depressive symptoms (Strutt et al., 2012). "
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    ABSTRACT: Objectives: To evaluate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on alexithymia, a deficit in affective regulation, comparing patients with Parkinson’s disease (PD) submitted to STN-DBS (DBS group) to PD patients not yet treated with STN-DBS (pre-DBS group) and to healthy participants (C group). Methods: We recruited 27 consecutive STN-DBS PD patients, 38 consecutive pre-DBS patients and 27 healthy participants. Patients were assessed for alexithymia (Toronto Alexithymia Scale), depression, [beck depression inventory (BDI)], and cognitive functions (reasoning, memory, attentional, and executive tests). Results: The DBS patients performed worse than the pre-DBS patients in the corsi’s block-tapping test, in the phonemic fluency task and in the Frontal Assessment Battery. Around 30% of DBS (29.6%) and pre-DBS (31.6%) patients resulted alexithymic, compared with 14.8% in the C group. The results pointed out significantly higher alexithymia scores in both the DBS and pre-DBS groups compared with the C group, while no difference emerged between the DBS and pre-DBS groups. Pre-DBS group showed a significantly higher BDI score than the C group, while DBS group did not. Conclusion: Although the results suggest that STN-DBS does not affect alexithymia, both the DBS and pre-DBS patients reported higher prevalence (about 30%) of alexithymia than did healthy subjects (14.8%).
    Frontiers in Psychology 10/2014; 5(1168). DOI:10.3389/fpsyg.2014.01168 · 2.80 Impact Factor
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    • "In DBS/PD-research test instruments based on the categorical approach such as the Structured Clinical Interview for DSM disorders (SCID-II) have occasionally been used [55]. However, we doubt that these instruments are adequate for our purpose: It is conceivable that the implantation and subsequent stimulation of neural tissues may cause some pathological changes in personality. "
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    ABSTRACT: Ethical evaluation of deep brain stimulation as a treatment for Parkinson’s disease is complicated by results that can be described as involving changes in the patient’s identity. The risk of becoming another person following surgery is alarming for patients, caregivers and clinicians alike. It is one of the most urgent conceptual and ethical problems facing deep brain stimulation in Parkinson’s disease at this time. In our paper we take issue with this problem on two accounts. First, we elucidate what is meant by “becoming another person” from a conceptual point of view. After critically discussing two broad approaches we concentrate on the notion of “individual identity” which centers on the idea of “core attitudes”. Subsequently we discuss several approaches to determine what distinguishes core attitudes from those that are more peripheral. We argue for a “foundational-function model” highlighting the importance of specific dependency relations between these attitudes. Our second aim is to comment on the possibility to empirically measure changes in individual identity and argue that many of the instruments now commonly used in selecting and monitoring DBS-patients are inappropriate for this purpose. Future research in this area is advised combining a conceptual and an empirical approach as a basis of sound ethical appraisal. KeywordsNeuroethics–Deep brain stimulation–Personal identity–Parkinson’s disease–Personality measurement
    Neuroethics 01/2013; 6(3):1-13. DOI:10.1007/s12152-011-9100-1 · 1.04 Impact Factor
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    • "nie zaburzeń poznawczych. Wiek może bardziej sprzyjać wystąpieniu deficytów niż problemy związane z procedurą zabiegu (Saint-Cyr i wsp. 2000). Pogorszenie ogólnego funkcjonowania po znawczego w wyniku stymulacji opisują w swej monografii również Castelli i wsp. (2006). Zaobserwowali oni w swych badaniach deficyty u 3 spośród 65 badanych pacjentów (Castelli i wsp. 2006). Ponadto także Williams i wsp. (2011) w swych 2-letnich badaniach stwierdzili wystąpienie zaburzeń u niektórych pacjentów. Autorzy zauważyli, że w ciągu 2 lat obserwacji przypadki wystąpienia demencji pojawiały się zarówno w grupie osób po zabiegu, jak i grupie kontrolnej. Jednakże pacjenci po DBS, u których zdiagnozowano łagodne zabur"
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    ABSTRACT: ENG Deep brain stimulation surgery (DBS) is a relatively new method of therapy proposed to patients suffering from Parkinson's disease (PD), especially when the traditional dopatherapy appears to be insufficient or when patients experience side effects associated with this kind of treatment (dyskinesias, fluctuations). The effectiveness of the surgery in improving motor functions has been confirmed in a number of studies. However, its impact on cognitive functions still remains a controversial issue. There are many contradictory reports in this area. The purpose of this review is to combine the previous studies about cognitive functioning of PD patients who underwent DBS surgery of the subthalamic nucleus. According to the previous studies, this area seems to be one of the best stereotactic targets and allows clinicians to reduce the daily doses of levodopa by up to 84%. The article presents previous reports about the influence of the surgery on the cognitive functions of verbal fluency, visuo-spatial, executive functions, memory, attention and concentration, and global cognitive profile presented by the patients. Furthermore, the possible factors that may have an impact on the deterioration in cognitive functions after the surgery are also discussed in this paper. It seems that knowledge about latest reports about patients' functioning after DBS surgery is important both for the specialist and the patients due to the more conscious choice of this method of treatment. What is more, this knowledge may indicate the importance of careful and constant observation of the patient who underwent the surgery. PL Zabieg głębokiej stymulacji mózgu (deep brain stimulation – DBS) jest stosunkowo nowym sposobem terapii proponowanym pacjentom cierpiącym na chorobę Parkinsona, dla których tradycyjne leczenie preparatami lewodopy okazuje się niewystarczające lub też gdy doświadczają oni przykrych objawów ubocznych związanych z takim leczeniem (dyskinezy, fluktuacje). Skuteczność zabiegu w zakresie poprawy funkcjonowania motorycznego chorych została potwierdzona w wielu badaniach i jest niewątpliwym sukcesem. Wpływ zabiegu na funkcje poznawcze i emocjonalne wciąż jednak pozostaje kwestią kontrowersyjną. Istnieje wiele sprzecz-nych doniesień na ten temat. Celem niniejszego artykułu poglądowego jest próba zestawienia badań z zakresu funkcjonowania poznawczego pacjentów z chorobą Parkinsona, którzy zostali poddani zabiegowi głębokiej stymulacji jądra niskowzgórzowego. Obszar ten, jak dowiedziono w badaniach, wydaje się jednym z najlepszych celów stereotaktycznych, pozwalających na ograniczenie dobowych dawek lewodopy nawet do 84%. W artykule przedstawiono wpływ DBS na funkcje językowe, wzrokowo-przestrzenne, wykonawcze, pamięć, uwagę i koncentrację oraz globalny profil poznawczy prezentowany przez chorych. Podjęto także próbę wskazania czynników mogących mieć wpływ na pogorszenie funkcjonowania poznawczego po zabiegu. Zapoznanie się z najnowszymi doniesieniami na temat funkcjonowania pacjentów po zabiegu DBS wydaje się ważne ze względu na bardziej świadomy wybór tego sposobu leczenia przez specjalistów oraz pacjentów. Ponadto może to wskazywać, jak ważna jest uważna, stała obserwacja i opieka nad pacjentem ze wszczepionym stymulatorem.
    Neuropsychiatria i Neuropsychologia 01/2013; 8(1):32-39.
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