丘脑底核深部脑电刺激术对帕金森病患者神经心理功能的影响

Effect of Subthalamic Nucleus Deep Brain Stimulation on Neuropsychological Outcomes in Parkinson's Disease Patients

目的:探讨帕金森(PD)患者丘脑底核深部脑电刺激术(STN-DBS)后神经心理功能的变化特征。方法:共纳入2014年12月到2016年3月武汉大学中南医院诊断的42例PD患者,分为手术组(接受STN-DBS,同时服用抗PD药物)和对照组(仅服用抗PD药物)。在基线期和6月随访期,服用抗PD药物和电刺激的状态下,收集一般人口学信息,并用统一帕金森评分量表、艾森布鲁克认知检测-修订版、Hoehn-Yahr分期、Schwab-England日常生活能力、汉密尔顿焦虑和抑郁量表对患者的精神、日常生活能力、运动症状、药物并发症、定向力和注意力、记忆、语言流畅性、语言、视空间、疾病分期、焦虑和抑郁进行评测。用配对t检验或Wilcoxon符号秩和检验比较基线和随访期资料,用独立样本t检验或Mann-Whitney U检验比较手术组和对照组资料。结果:手术组PD患者术后总体认知功能未见明显变化,语言流畅性显著下降(P=0.022)。与对照组相比,手术组PD患者运动能力(P=0.000)、日常生活能力(P=0.047)、抑郁(P=0.009)和焦虑(P=0.003)症状显著改善,服用抗帕金森药物减少(P=0.000)。结论:STN-DBS对PD患者认知功能总体安全,可改善患者日常生活能力、抑郁、焦虑和运动等症状。本前瞻性研究可为中晚期PD患者接受STN-DBS治疗提供一定的指导意义。

Objective：To investigate theneuropsychological changes after subthalamic nucleus deep brain stimulation（STN-DBS）in patients with Parkinson＇s disease（PD）.Methods：From December2014 to March 2016,42 patients diagnosed PD in Zhongnan Hospital of Wuhan University（21received STN-DBS plus dopatherapy,21 received dopatherapy only）were recruited and assessed at both baseline and 6-month follow-up with Unified Parkinson Disease Rating Scale（activity of daily life,motor symptoms,drug complications）,Addenbrooke＇s Cognitive Examination-Revised（orientation and attention,memory,verbal fluency,language and visuospatial ability）,Hoehn-Yahr stage（disease stage）,Schwab-England activity of daily life,Hamilton anxiety scale（anxiety）and Hamilton depression scale（depression）in the medication-on/stimulation-on condition.Changesbetween baseline and follow-up were compared by paired-t test or Wilcoxon signed rank test while changes between the two groups were compared by independent-t test or Mann-Whitney U test.Results：No significant change occurred in global cognition,while a slight decrease in verbal fluency during 6-month follow-up was detected（P=0.022）.Compared with control group,STNDBS was related with motor symptoms（P =0.000）,activity of daily life（P=0.047）,depression（P=0.009）,anxiety（P=0.003）improvement,as well as less anti-parkinsonism drug（P=0.000）.Conclusion：STN-DBS is relatively safe with respect to cognition.Considering the improvement in activity of daily life,depression,anxiety and motor abilities,our study might give physicians positive guidance towards surgery treatment of advanced PD patients.