A single-center 5-year follow-up study on the effects of bilateral deep brain stimulation on mood and cognition in patients with Parkinson's disease
Objective To explore the effect of deep brain stimulation of bilateral subthalamic nucleus(STN-DBS)on the mood and cognition in patients with Parkinson's disease(PD).Methods The clinical data of 80 PD patients who underwent bilateral STN-DBS treatment at the Functional Neurosurgery of Affiliated Brain Hospital of Nanjing Medical University from April 2014 to December 2016 were retrospectively analyzed 5 years after surgery.Before surgery,6 months after surgery,and 1,2,3,4,and 5 years later,the patients were assessed based on the Unified Parkinson's Disease Rating Scale Part Ⅲ(UPDRS-Ⅲ),the 39-item PD Quality of Life Questionnaire in the off state(PDQ-39),Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD),Mini-Mental State Examination(MMSE)and Montreal Cognitive Assessment(MoCA);the L-dopa equivalent daily dose(LED)was calculated.We compared the changes in scores of patients and the LEDD before and after surgery,and analyze the correlation between the improvement of motor symptoms(UPDRS-Ⅲ score),quality of life(PDQ-39 score)and the improvement rate of MMSE,MoCA,HAMA,and HAMD scores.Results Compared with those before surgery,the patient's UPDRS-Ⅲ score(off period),LEDD,PDQ-39 score,HAMA score,and HAMD score at 6 months,1,2,3,4,and 5 years after surgery were all significantly reduced,the MoCA scores were all higher than those before surgery,and the differences were statistically significant(all P＜0.05).The MMSE scores at 6 months,1,2,3,and 4 years after surgery were higher than those before surgery,and the differences were statistically significant(all P＜0.05),while the MMSE scores at 5 years after surgery were not different from those before surgery(P＞0.05).Spearman rank correlation analysis results showed that there was a positive correlation between the patient's MMSE score improvement rate at 1,3,and 5 years after surgery and the PDQ-39 score improvement rate at the same time points(1 year after surgery:rs=0.26,P=0.026;3 years after surgery:rs=0.23,P=0.043;5 years after surgery:rs=0.35,P=0.002).There was a positive correlation(rs=0.28,P=0.014)between the MoCA score improvement rate 5 years after surgery and the PDQ-39 score improvement rate corresponding to the same time point.There was no significant correlation between the patient's MMSE,MoCA,HAMA,and HAMD score improvement rates at 1,3,and 5 years after surgery and the UPDRS-Ⅲ score improvement rate at the corresponding time points(all P＞0.05).Conclusions Bilateral STN-DBS is long-term effective in improving anxiety,depression and overall cognitive function in PD patients.The improvement in overall cognitive function in PD patients is related to the improvement in quality of life.
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