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J Neurol Neurosurg Psychiatry 1999;66:297-304 doi:10.1136/jnnp.66.3.297
  • Paper

Cognitive outcome after unilateral pallidal stimulation in Parkinson’s disease

  1. Guy Vingerhoetsa,
  2. Chris van der Lindenb,
  3. Engelien Lannooa,
  4. Veerle Vandewallec,
  5. Jacques Caemaertc,
  6. Mercedes Woltersa,
  7. Dirk Van den Abbeeleb
  1. aDepartment of Psychiatry and Neuropsychology, University Hospital Ghent, Belgium, bDepartment of Neurology, University Hospital Ghent, Belgium, cDepartment of Neurosurgery, University Hospital Ghent, Belgium
  1. 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
  • Revised 8 September 1998
  • Accepted 22 September 1998

Abstract

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.

METHODS Twenty 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.

RESULTS Neurological 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.

CONCLUSIONS Left 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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