Neuropsychological outcome after deep brain stimulation for Parkinson disease.
OBJECTIVE
To assess the neuropsychological outcome 12 months after bilateral deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) or subthalamic nucleus (STN) for advanced Parkinson disease.


METHODS
We randomly assigned patients to receive either GPi DBS or STN DBS. Standardized neuropsychological tests were performed at baseline and after 12 months. Patients and study assessors were masked to treatment allocation.


RESULTS
Univariate analysis of change scores indicated group differences on Stroop word reading and Stroop color naming (confidence interval [CI] 1.9-10.0 and 2.1-8.8), on Trail Making Test B (CI 0.5-10.3), and on Wechsler Adult Intelligence Scale similarities (CI -0.01 to 1.5), with STN DBS showing greater negative change than GPi DBS. No differences were found between GPi DBS and STN DBS on the other neuropsychological tests. Older age and better semantic fluency at baseline predicted cognitive decline after DBS.


CONCLUSIONS
We found no clinically significant differences in neuropsychological outcome between GPi DBS and STN DBS. No satisfactory explanation is available for the predictive value of baseline semantic fluency for cognitive decline.


METHODS
This study provides Class I evidence that there is no large difference in neuropsychological outcome between GPi DBS and STN DBS after 12 months. The study lacks the precision to exclude a moderate difference in outcomes.
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands. v.j.odekerken@amc.uva.nl.
Vincent J J
VJ
Odekerken
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Judith A
JA
Boel
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Gert J
GJ
Geurtsen
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Ben A
BA
Schmand
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
I P
IP
Dekker
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Rob J
RJ
de Haan
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
P Richard
PR
Schuurman
From the Department of Neurology (V.J.J.O., J.A.B., G.J.G., B.A.S., I.P.D., R.M.A.d.B.), the Clinical Research Unit (R.J.d.H.), and the Department of Neurosurgery (P.R.S.), Academic Medical Center, Amsterdam; and the Department of Psychology (J.A.B., B.A.S.), University of Amsterdam, the Netherlands.
Rob M A
RM
de Bie
D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005917:Globus Pallidus / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D020531:Subthalamic Nucleus / Q000502:physiology; D016896:Treatment Outcome