Anterior lead location predicts verbal fluency decline following STN-DBS in Parkinson's disease

Background. Deep brain stimulation of the subthalamic nucleus (STN-DBS) has been shown to be generally safe from a cognitive perspective, with consistent evidence that the major impact of STN-DBS in Parkinson’s disease (PD) is on verbal fluency. Objective. The aim of this study was first to identify the influence of acute manipulation of STN-DBS in PD on the number and time pattern of word generation on different verbal fluency (VF) tasks, phonemic, switching, and cued switching, and second to determine whether cueing improved VF and if cueing effects interacted with STN-DBS effects. Methods. Parallel versions of these three verbal fluency tasks were completed by 31 patients with Parkinson’s disease who had had bilateral DBS of the STN, twice, with DBS On and Off, with the order counterbalanced across patients. Results. There was no effect of acute STN-DBS on the total number of words generated during verbal fluency. As expected, the number of words generated significantly declined over the six 10-second intervals of the verbal fluency tasks, but this time pattern of word generation was not altered by STN-DBS. External cueing significantly increased the number of words generated relative to an uncued switching verbal fluency task, but the cueing effect on VF was not altered by STN-DBS. Conclusion. In conclusion, (i) acute STN-DBS manipulation did not alter either verbal fluency performance or the time pattern of word generation and (ii) external cueing significantly improved verbal fluency performance both with STN-DBS On and Off.

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Deep Brain Stimulation Frequency of the Subthalamic Nucleus Affects Phonemic and Action Fluency in Parkinson’s Disease

Parkinson s Disease ◽

10.1155/2016/6760243 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Valéria de Carvalho Fagundes ◽

Carlos R. M. Rieder ◽

Aline Nunes da Cruz ◽

Bárbara Costa Beber ◽

Mirna Wetters Portuguez

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

High Frequency ◽

Verbal Fluency ◽

Low Frequency ◽

Stn Dbs ◽

Deep Brain

Introduction.Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson’s disease (PD) has been linked to a decline in verbal fluency. The decline can be attributed to surgical effects, but the relative contributions of the stimulation parameters are not well understood. This study aimed to investigate the impact of the frequency of STN-DBS on the performance of verbal fluency tasks in patients with PD.Methods.Twenty individuals with PD who received bilateral STN-DBS were evaluated. Their performances of verbal fluency tasks (semantic, phonemic, action, and unconstrained fluencies) upon receiving low-frequency (60 Hz) and high-frequency (130 Hz) STN-DBS were assessed.Results.The performances of phonemic and action fluencies were significantly different between low- and high-frequency STN-DBS. Patients showed a decrease in these verbal fluencies for high-frequency STN-DBS.Conclusion.Low-frequency STN-DBS may be less harmful to the verbal fluency of PD patients.

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Neuropsychiatric Symptoms in Parkinson's Disease After Subthalamic Nucleus Deep Brain Stimulation

Frontiers in Neurology ◽

10.3389/fneur.2021.656041 ◽

2021 ◽

Vol 12 ◽

Author(s):

Weibing Liu ◽

Tatsuya Yamamoto ◽

Yoshitaka Yamanaka ◽

Masato Asahina ◽

Tomoyuki Uchiyama ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Verbal Fluency ◽

Neuropsychiatric Symptoms ◽

Motor Symptoms ◽

Frontal Lobe Functions ◽

Stn Dbs ◽

Updrs Part ◽

Deep Brain

Background: Indications for subthalamic nucleus deep brain stimulation (STN-DBS) surgery are determined basically by preoperative motor function; however, postoperative quality of life (QOL) is not necessarily associated with improvements in motor symptoms, suggesting that neuropsychiatric symptoms might be related to QOL after surgery in patients with Parkinson's disease.Objectives: We aimed to examine temporal changes in neuropsychiatric symptoms and their associations with QOL after STN-DBS.Materials and Methods: We prospectively enrolled a total of 61 patients with Parkinson's disease (mean age = 65.3 ± 0.9 years, mean disease duration = 11.9 ± 0.4 years). Motor function, cognitive function, and neuropsychiatric symptoms were evaluated before and after DBS surgery. Postoperative evaluation was performed at 3 months, 1 year, and 3 years after surgery.Results: Of the 61 participants, 54 completed postoperative clinical evaluation after 3 months, 47 after 1 year, and 23 after 3 years. Frontal lobe functions, depression, and verbal fluency significantly worsened 3 years after STN-DBS. Non-motor symptoms such as impulsivity and the Unified PD Rating Scale (UPDRS) part I score were associated with QOL after STN-DBS.Conclusions: Frontal lobe functions, depression, and verbal fluency significantly worsened 3 years after STN-DBS. The UPDRS part I score and higher impulsivity might be associated with QOL after STN-DBS.

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Brain networks underlining verbal fluency decline during STN-DBS in Parkinson's disease: An ECD-SPECT study

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2006.11.011 ◽

2007 ◽

Vol 13 (5) ◽

pp. 290-294 ◽

Cited By ~ 42

Author(s):

Roberto Cilia ◽

Chiara Siri ◽

Giorgio Marotta ◽

Danilo De Gaspari ◽

Andrea Landi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Verbal Fluency ◽

Brain Networks ◽

Stn Dbs

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Effects of Deep Brain Stimulation in the Subthalamic Nucleus on Neurocognitive Function in Patients With Parkinson's Disease Compared With Medical Therapy: A Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.610840 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jiazhen Wang ◽

Ru Pan ◽

Ying Cui ◽

Zhigang Wang ◽

Qinghua Li

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Learning And Memory ◽

Verbal Fluency ◽

Therapy Group ◽

Neurocognitive Function ◽

Function Evaluation ◽

Motor Symptoms ◽

Memory Ability ◽

Stn Dbs

Background: DBS has been shown to significantly affect motor symptoms in Parkinson's disease (PD). However, some studies have suggested that it may have adverse effects on patients' neurocognitive function. To clarify this operation's effect on neurocognitive function, we collected studies containing neurocognitive function evaluation for qualitative and quantitative analysis.Methods: We searched relevant clinical studies through Pubmed and Embase databases and extracted and sorted out information such as sample size, post-operative scores, pre-operative and post-operative evaluation interval, PD course, and exclusion criteria, from articles meeting the standards. The magnitude and variance of the DBS group's combined effects and the drug therapy group in each neurocognitive domain were calculated and analyzed by the random-effects model.Results: Compared with the drug treatment group, the verbal fluency of patients in the experimental group was significantly decreased at least moderately (ES = −0.553), in which the phonemic fluency declines greatly (ES = −0.842), learning and memory ability was slightly decreased (ES = −0.305), and other neurocognitive functions were not significantly decreased.Conclusion: STN-DBS can affect verbal fluency and damage learning and memory. There was no significant correlation between the above effects and disease progression itself, and it was more likely to be associated with STN-DBS. It is suggested that post-operative patients should be trained and evaluated regularly for their verbal fluency and learning and memory ability. The safety of STN-DBS is acceptable for the majority of patients with motor symptoms.

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Subthalamic stimulation affects homophone meaning generation in Parkinson's disease

Journal of the International Neuropsychological Society ◽

10.1017/s1355617708081046 ◽

2008 ◽

Vol 14 (5) ◽

pp. 890-894 ◽

Cited By ~ 4

Author(s):

JOANNA E. CASTNER ◽

DAVID A. COPLAND ◽

PETER A. SILBURN ◽

TERRY J. COYNE ◽

FELICITY SINCLAIR ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Verbal Fluency ◽

Neurologically Impaired ◽

Stimulation Condition ◽

Subthalamic Stimulation ◽

Stn Dbs ◽

Generation Test ◽

Deep Brain

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) in individuals with Parkinson's disease (PD) has often been associated with reduced verbal fluency performance. This study aimed to directly assess semantic switching as a function of STN stimulation in PD participants with the Homophone Meaning Generation Test (HMGT). Seventeen participants with PD who had received STN DBS completed the HMGT in on and off stimulation conditions. Twenty-one non-neurologically impaired participants acted as controls. PD participants (in both on and off stimulation conditions) generated significantly fewer meanings than control participants and consistent with the previous reports of verbal fluency impairment, PD participants produced fewer definitions in the on stimulation condition. PD participants (in both on and off stimulation conditions) also had greater difficulty generating definitions for nonhomographic homophones compared with homographic homographs. The results of this study indicate that STN stimulation exacerbates impairment in semantic switching. (JINS, 2008, 14, 890–894.)

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Does early verbal fluency decline after STN implantation predict long-term cognitive outcome after STN-DBS in Parkinson's disease?

Journal of the Neurological Sciences ◽

10.1016/j.jns.2014.07.063 ◽

2014 ◽

Vol 346 (1-2) ◽

pp. 299-302 ◽

Cited By ~ 10

Author(s):

Alaina Borden ◽

David Wallon ◽

Romain Lefaucheur ◽

Stéphane Derrey ◽

Damien Fetter ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Verbal Fluency ◽

Cognitive Outcome ◽

Stn Dbs

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Different outcomes of phonemic verbal fluency in Parkinson’s disease patients with subthalamic nucleus deep brain stimulation

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170024 ◽

2017 ◽

Vol 75 (4) ◽

pp. 216-220 ◽

Cited By ~ 1

Author(s):

Aline Juliane Romann ◽

Bárbara Costa Beber ◽

Maira Rozenfeld Olchik ◽

Carlos R M. Rieder

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Verbal Fluency ◽

Phonemic Fluency ◽

Phonemic Verbal Fluency ◽

Stn Dbs ◽

Deep Brain

ABSTRACT Subthalamic nucleus deep brain stimulation (STN-DBS) is a surgical technique to treat motor symptoms in patients with Parkinson’s disease (PD). Studies have shown that STN-DBS may cause a decline in verbal fluency performance. We aimed to verify the effects of STN-DBS on the performance of phonemic verbal fluency in Brazilian PD patients. Sixteen participants were evaluated on the Unified Parkinson’s Disease Rating Scale - Part III and for phonemic fluency (“FAS” version) in the conditions of on- and off-stimulation. We identified two different patterns of phonemic verbal fluency outcomes. The results indicate that there may be no expected pattern of effect of bilateral STN-DBS in the phonemic fluency, and patients may present with different outcomes for some reason not well understood.

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Verbal Fluency in Parkinson’s Patients with and without Bilateral Deep Brain Stimulation of the Subthalamic Nucleus: A Meta-analysis

Journal of the International Neuropsychological Society ◽

10.1017/s1355617716000035 ◽

2016 ◽

Vol 22 (4) ◽

pp. 478-485 ◽

Cited By ~ 13

Author(s):

Kathryn A. Wyman-Chick

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Effect Size ◽

Verbal Fluency ◽

Comparison Group ◽

Random Effects Model ◽

Stn Dbs ◽

Deep Brain ◽

Stimulation Of

AbstractObjectives: Patients with Parkinson’s disease often experience significant decline in verbal fluency over time; however, deep brain stimulation of the subthalamic nucleus (STN-DBS) is also associated with post-surgical declines in verbal fluency. The purpose of this study was to determine if Parkinson’s patients who have undergone bilateral STN-DBS have greater impairment in verbal fluency compared to Parkinson’s patients treated by medication only. Methods: A literature search yielded over 140 articles and 10 articles met inclusion criteria. A total of 439 patients with Parkinson’s disease who underwent bilateral STN-DBS and 392 non-surgical patients were included. Cohen’s d, a measure of effect size, was calculated using a random effects model to compare post-treatment verbal fluency in patients with Parkinson’s disease who underwent STN-DBS versus those in the non-surgical comparison group. Results: The random effects model demonstrated a medium effect size for letter fluency (d=−0.47) and a small effect size for category fluency (d=−0.31), indicating individuals with bilateral STN-DBS had significantly worse verbal fluency performance than the non-surgical comparison group. Conclusions: Individuals with Parkinson’s disease who have undergone bilateral STN-DBS experience greater deficits in letter and category verbal fluency compared to a non-surgical group. (JINS, 2016, 22, 478–485)

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Which Neuropsychological Tests? Predicting Cognitive Decline and Dementia in Parkinson’s Disease in the ICICLE-PD Cohort

Journal of Parkinson s Disease ◽

10.3233/jpd-212581 ◽

2021 ◽

pp. 1-12

Author(s):

Rachael A. Lawson ◽

Caroline H. Williams-Gray ◽

Marta Camacho ◽

Gordon W. Duncan ◽

Tien K. Khoo ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Verbal Fluency ◽

Neuropsychological Tests ◽

Visual Memory ◽

Attention And Memory ◽

Memory And Attention ◽

Global Cognition

Background: Cognitive impairment is common in Parkinson’s disease (PD), with 80% cumulatively developing dementia (PDD). Objective: We sought to identify tests that are sensitive to change over time above normal ageing so as to refine the neuropsychological tests predictive of PDD. Methods: Participants with newly diagnosed PD (n = 211) and age-matched controls (n = 99) completed a range of clinical and neuropsychological tests as part of the ICICLE-PD study at 18-month intervals over 72 months. Impairments on tests were determined using control means (<1-2SD) and median scores. Mild cognitive impairment (PD-MCI) was classified using 1-2SD below normative values. Linear mixed effects modelling assessed cognitive decline, while Cox regression identified baseline predictors of PDD. Results: At 72 months, 46 (cumulative probability 33.9%) participants had developed PDD; these participants declined at a faster rate in tests of global cognition, verbal fluency, memory and attention (p < 0.05) compared to those who remained dementia-free. Impaired baseline global cognition, visual memory and attention using median cut-offs were the best predictors of early PDD (area under the curve [AUC] = 0.88, p < 0.001) compared to control-generated cut-offs (AUC = 0.76–0.84, p < 0.001) and PD-MCI (AUC] = 0.64–0.81, p < 0.001). Impaired global cognition and semantic fluency were the most useful brief tests employable in a clinical setting (AUC = 0.79, p < 0.001). Conclusion: Verbal fluency, attention and memory were sensitive to change in early PDD and may be suitable tests to measure therapeutic response in future interventions. Impaired global cognition, attention and visual memory were the most accurate predictors for developing a PDD. Future studies could consider adopting these tests for patient clinical trial stratification.

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