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Deep Brain Stimulation of the Subthalamic Nucleus Improves Cognitive Flexibility but Impairs Response Inhibition in Parkinson Disease
Karsten Witt, MD;
Ulrich Pulkowski, MD;
Jan Herzog, MD;
Delia Lorenz, MD;
Wolfgang Hamel, MD;
Günther Deuschl, MD;
Paul Krack, MD
Arch Neurol. 2004;61:697-700.
Background Deep brain stimulation of the subthalamic nucleus (STN) improves motor symptoms of Parkinson disease. Although several studies have assessed cognitive functions before surgery and after long-term STN stimulation, only a few have assessed patients while stimulation is on and off to more specifically address the short-term cognitive effects of STN deep brain stimulation.
Objective To examine the short-term effects of STN stimulation on several tests sensitive to executive function and the long-term effects of STN stimulation on a global cognitive scale.
Design Twenty-three patients with Parkinson disease were tested 6 to 12 months after surgery with STN stimulation switched on and off in a random order while taking their regular medication. The Unified Parkinson's Disease Rating Scale motor score was also rated in the on and off stimulation condition. The neuropsychological battery included digit span, verbal fluency, Stroop color test, and random number generation in a single- and dual-task condition.
Results Short-term stimulation improved the results on the Random Number Generation Task, requiring suppression of habitual responses, but induced more errors in the interference task of the Stroop color test. Digit span, verbal fluency, and dual-task performance results did not change. There was a significant correlation (r = 0.47, P = .02) between improved performance on the Random Number Generation Task and impaired response inhibition in the Stroop interference condition. A preoperative to postoperative comparison showed no changes in global cognitive function with long-term STN deep brain stimulation.
Conclusions Short-term STN stimulation improves cognitive flexibility (giving up habitual responses) but impairs response inhibition. Long-term STN stimulation does not change global cognitive function.
From the Departments of Neurology (Drs Witt, Pulkowski, Herzog, Lorenz, Deuschl, and Krack) and Neurosurgery (Dr Hamel), Christian-Albrechts-University Kiel, Kiel, Germany.
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