title: Frontal FDG-PET activity correlates with cognitive outcome after STN-DBS in Parkinson disease.
abstract: BACKGROUND
  Inconsistent changes of cognitive functioning have been reported in patients with Parkinson disease (PD) with deep brain stimulation (DBS) of the subthalamic nucleus (STN). To investigate the underlying pathomechanisms, we correlated alterations of cognitive test performance and changes of neuronal energy metabolism in frontal basal ganglia projection areas under bilateral STN stimulation.
  
  
  METHODS
  We conducted verbal fluency, learning, and memory tests and 18-fluorodeoxyglucose (FDG) PET in nine patients with PD with STN-DBS before and 6 months after surgery. Using coregistered MRI, postoperative changes of the normalized cerebral metabolic rates of glucose (nCMRGlc) in the dorsolateral prefrontal cortex (DLPFC), lateral orbitofrontal cortex (LOFC), ventral and dorsal cingulum (v/dACC), and in Broca area were determined and correlated with alterations of neuropsychological test results.
  
  
  RESULTS
  After surgery, highly variable changes of both cognitive test performance and frontal nCMRGlc values were found with significant correlations between verbal fluency and FDG uptake in the left DLPFC (Brodmann area [BA] 9, 46), left Broca area (BA 44/45), and the right dACC (BA 32). A decrease of nCMRGlc in the left OFC (BA 11/47) and dACC (BA 32) correlated with a decline of verbal learning. All patients showed reduced metabolic activity in the right anterior cingulate cortex after DBS. Baseline cognitive abilities did not predict verbal learning or fluency changes after surgery.
  
  
  CONCLUSIONS
  These data show a significant linear relationship between changes in frontal 18-fluorodeoxyglucose PET activity and changes in cognitive outcome after deep brain stimulation of the subthalamic nucleus (STN) in advanced Parkinson disease. The best correlations were found in the left frontal lobe (dorsolateral prefrontal cortex and Broca area). Baseline performance on cognitive tests did not predict cognitive or metabolic changes after STN electrode implantation.
authors.affiliation: Department of Neurology, University of Cologne, Germany. elke.kalbe@uk-koeln.de
authors.forename: E
authors.initials: E
authors.lastname: Kalbe
authors.forename: J
authors.initials: J
authors.lastname: Voges
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Haarer
authors.forename: S
authors.initials: S
authors.lastname: Baudrexel
authors.forename: J C
authors.initials: JC
authors.lastname: Klein
authors.forename: J
authors.initials: J
authors.lastname: Kessler
authors.forename: V
authors.initials: V
authors.lastname: Sturm
authors.forename: W D
authors.initials: WD
authors.lastname: Heiss
authors.forename: R
authors.initials: R
authors.lastname: Hilker
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003071:Cognition / Q000502:physiology*; D016001:Confidence Intervals; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016017:Odds Ratio; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D049268:Positron-Emission Tomography; D020531:Subthalamic Nucleus / Q000000981:diagnostic imaging / Q000502:physiology*
chemical_list: D019788:Fluorodeoxyglucose F18