Cognitive outcome following pallidotomy: the influence of side of surgery and age of patient at disease onset.
OBJECTIVE
The authors studied the neuropsychological correlates of stereotactically guided lesioning of the right and left posteroventral globus pallidus internus (GPi) in a prospective series of patients suffering from Parkinson's disease (PD).


METHODS
Eighteen patients with PD who underwent stereotactically guided lesioning of the GPi (left side in 10 patients and right side in eight) completed neuropsychological evaluations before and after surgery. Patients served as their own controls. Multiple two-by-two repeated-measures analyses of variance were used to assess neuropsychological changes as a function of the side in which lesioning was performed (lesioning on the left side compared with that on the right) and surgery (presurgery compared with postsurgery). Relationships between cognitive variables and patient age at disease onset, age at surgery, and disease duration were examined using a linear regression model. The most striking findings were evident from results of a phonemic word fluency test in which patients in whom a left-sided pallidotomy had been performed achieved a mean performance score that was lower than the score of patients in whom a right-sided pallidotomy had been performed; this score declined even more as a result of surgery. Change in performance on the word fluency test across pre- and postoperative assessments was also related to patient age at onset of PD in those who had undergone left-sided pallidotomy, with patients of an older age at disease onset showing the greatest decline in performance.


CONCLUSIONS
These preliminary findings indicate that the side on which surgery was performed and patient age at onset of PD are important in the prediction of postoperative cognitive outcome. The findings also indicate that stereotactically guided lesioning of the GPi presents a relatively mild cognitive risk.
Kubu
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Department of Clinical Neurological Sciences, University of Western Ontario, and Clinical Neurological Sciences, London Health Sciences Centre, Canada. ckubu@julian.uwo.ca
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D000328:Adult; D000367:Age Factors; D000368:Aged; D000849:Anomia / Q000175:diagnosis / Q000503:physiopathology; D001037:Aphasia / Q000175:diagnosis / Q000503:physiopathology; D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000503:physiopathology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology / Q000601:surgery*; D010700:Phonetics; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D013238:Stereotaxic Techniques