Comparative cognitive effects of bilateral subthalamic stimulation and subcutaneous continuous infusion of apomorphine in Parkinson's disease.
Bilateral subthalamic deep brain stimulation (STN-DBS) and continuous subcutaneous infusion of apomorphine (APM-csi) can provide a comparable improvement on motor function in patients with advanced Parkinson's disease (PD), but the mechanisms by which both therapies exert their effects are different. We analyzed the cognitive effects of APM-csi. We also compared neuropsychological effects induced by STN-DBS and APM-csi in advanced PD to ascertain the neuropsychological aspects relevant in determining the therapeutic procedure that is the most appropriate in a particular patient. We studied 9 patients treated with STN-DBS and 7 patients with APM-csi. Neuropsychological measures included Rey's Auditory-Verbal Learning, Stroop, Trail Making, phonetic verbal fluency, and Judgment of Line Orientation tests. In the APM-csi group, significant changes were not observed in the neuropsychological tests performance. By contrast, in the STN-DBS group, moderate worsening was found in phonetic verbal fluency and Stroop Naming scores that was partially reversible at long-term follow-up and did not have consequences on regular activities. Consequently, these findings could be interpreted as being not relevant in deciding the most suitable treatment in a given patient.
Alegret
Montse
M
Parkinson's Disease and Movement Disorders Unit, Service of Neurology, Institut de Malalties del Sistema Nerviós, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
Valldeoriola
Francesc
F
Martí
MaJosé
M
Pilleri
Manuela
M
Junqué
Carme
C
Rumià
Jordi
J
Tolosa
Eduardo
E
D000368:Aged; D001058:Apomorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004567:Electrodes, Implanted; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus; D013997:Time Factors
D018491:Dopamine Agonists; D001058:Apomorphine