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a Department of
Psychiatry and Neuropsychology, University Hospital Ghent, Belgium, b Department of Neurology, University Hospital
Ghent, Belgium, c Department of Neurosurgery, University Hospital
Ghent, Belgium
Correspondence to: Dr G Vingerhoets, Department of Psychiatry and Neuropsychology, University Hospital Ghent 4K3, De Pintelaan 185, B-9000 Ghent, Belgium. Telephone 0032 9 2404587; fax 0032 9 2404555.
Received 20 May 1998 and in revised form 8 September 1998;
Accepted 22 September
1998
OBJECTIVES
Chronic
high frequency electrostimulation of the globus pallidus internus
mimics pallidotomy and improves clinical symptoms in Parkinson's
disease. The aim of this study was to investigate the cognitive
consequences of unilateral deep brain stimulation.
METHODSTwenty
non-demented patients with Parkinson's disease (age range 38-70
years) were neuropsychologically assessed 2 months before and 3 months
after unilateral pallidal stimulation. The cognitive assessment
included measures of memory, spatial behaviour, and executive and
psychomotor function. In addition to group analysis of cognitive
change, a cognitive impairment index (CII) was calculated for each
individual patient representing the percentage of cognitive measures
that fell more than 1 SD below the mean of a corresponding normative sample.
RESULTSNeurological
assessment with the Hoehn and Yahr scale and the unified Parkinson's
disease rating scale disclosed a significant postoperative reduction in
average clinical Parkinson's disease symptomatology (p<0.001).
Repeated measures multivariate analysis of variance (using right/left
side of stimulation as a between subjects factor) showed no significant
postoperative change in cognitive performance for the total patient
group (main effect of operation). The side of stimulation did not show
a significant differential effect on cognitive performance (main effect
of lateralisation). There was no significant operation by
lateralisation interaction effect. Although the patients experienced
significant motor symptom relief after pallidal stimulation, they
remained mildly depressed after surgery. Analysis of the individual CII
changes showed a postoperative cognitive decline in 30% of the
patients. These patients were significantly older and took higher
preoperative doses of levodopa than patients showing no change or a
postoperative cognitive improvement.
CONCLUSIONSLeft or
right pallidal stimulation for the relief of motor symptoms in
Parkinson's disease seems relatively safe, although older patients and
patients needing high preoperative doses of levodopa seem to be more
vulnerable for cognitive decline after deep brain stimulation.
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