Short- and long-term cognitive effects of deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson’s disease

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OBJECTIVE

A growing number of studies are showing positive effects of deep brain stimulation (DBS) in the caudal zona incerta (cZi) in various tremor disorders, as well as motor symptoms of Parkinson’s disease (PD). The focus of the present study was to evaluate short- and long-term cognitive effects of bilateral cZi DBS in patients with PD.

METHODS

Twenty-five nondemented patients with advanced PD were recruited to participate in a randomized trial of cZi DBS versus best medical treatment (BMT). The patients in the BMT group were offered surgery after 6 months. Neuropsychological evaluations focusing on assessing verbal and visuospatial memory, attention, and executive function were conducted at baseline and at 6 and 24 months after surgery. Self-reported measures of depression, anxiety, and change in “frontal” behaviors were also completed at all assessment points.

RESULTS

Bilateral cZi DBS in patients with PD generated few adverse cognitive effects. At the short-term follow-up after 6 months, no differences were found between patients randomized to BMT and patients randomized to DBS with regard to most of the cognitive domains assessed. A transient improvement in anxiety was, however, found in the surgical group. At the long-term follow-up 24 months after cZi DBS, no major changes in global cognitive functioning were found, although a decline in attention and self-reported executive function was noted.

CONCLUSIONS

With the exception of a decline in attention and self-reported executive function, bilateral cZi DBS for PD in appropriately screened patients appears to be generally safe with regard to cognitive function, both in the short- and long-term perspective.

ABBREVIATIONS BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; BMT = best medical treatment; BVMT-R = Brief Visuospatial Memory Test-Revised; CWIT = Color Word Interference Test; cZi = caudal zona incerta; DBS = deep brain stimulation; FrSBe = Frontal Systems Behavioral Rating Scale; GPi = globus pallidus internus; MCI = mild cognitive impairment; PASAT = Paced Auditory Serial Addition Test; PD = Parkinson’s disease; PDQ-39 = Parkinson’s Disease Questionnaire; PSA = posterior subthalamic area; STN = subthalamic nucleus; TMT = Trail Making Test; UPDRS-III = Unified Parkinson’s Disease Rating Scale-III; Vim = ventral intermediate nucleus of the thalamus; WCST-64 = Wisconsin Card Sorting Test 64-card version.
Article Information

Contributor Notes

Correspondence Johanna Philipson: Umeå University, Umeå, Sweden. johanna.philipsson@umu.se.INCLUDE WHEN CITING Published online February 7, 2020; DOI: 10.3171/2019.12.JNS192654.Disclosures Dr. Hariz has received honoraria and travel expenses from Medtronic and Boston Scientific for speaking at meetings. Dr. Blomstedt is a consultant for Abbott, Boston Scientific, and Medtronic, and is a shareholder in Mithridaticum AB. Ms. Philipson has received scholarships and grants to cover travel expenses for attending national and international conferences and international research stays from the Swedish Neuropsychological Society, Neurofonden, Parkinsonförbundet, and Cederbergsstiftelsen.
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