ObjectiveThe aim of this study was to investigate the cognitive effects of unilateral directional versus ring subthalamic nucleus deep brain stimulation (STN DBS) in patients with advanced Parkinson's disease.MethodsWe examined 31 participants who underwent unilateral STN DBS (left n = 17; right n = 14) as part of an National Institutes of Health (NIH)‐sponsored randomized, double‐blind, crossover study contrasting directional versus ring stimulation. All participants received unilateral DBS implants in the hemisphere more severely affected by motor parkinsonism. Measures of cognition included verbal fluency, auditory‐verbal memory, and response inhibition. We used mixed linear models to contrast the effects of directional versus ring stimulation and implant hemisphere on longitudinal cognitive function.ResultsCrossover analyses showed no evidence for group‐level changes in cognitive performance related to directional versus ring stimulation. Implant hemisphere, however, impacted cognition in several ways. Left STN participants had lower baseline verbal fluency than patients with right implants (t [20.66 = −2.50, p = 0.02]). Verbal fluency declined after left (p = 0.013) but increased after right STN DBS (p < 0.001), and response inhibition was faster following right STN DBS (p = 0.031). Regardless of hemisphere, delayed recall declined modestly over time versus baseline (p = 0.001), and immediate recall was unchanged.InterpretationDirectional versus ring STN DBS did not differentially affect cognition. Similar to prior bilateral DBS studies, unilateral left stimulation worsened verbal fluency performance. In contrast, unilateral right STN surgery increased performance on verbal fluency and response inhibition tasks. Our findings raise the hypothesis that unilateral right STN DBS in selected patients with predominant right brain motor parkinsonism could mitigate declines in verbal fluency associated with the bilateral intervention. ANN NEUROL 2024

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单侧丘脑底核深部脑刺激对帕金森病的差异认知作用

目的本研究的目的是探讨单侧定向与环形底丘脑核深部脑刺激 (STN DBS) 对晚期帕金森病患者的认知效果。方法我们检查了 31 名接受单侧 STN DBS 的参与者（左侧）n= 17；正确的n= 14）作为美国国立卫生研究院 (NIH) 资助的一项随机、双盲、交叉研究的一部分，该研究对比了定向刺激与环形刺激。所有参与者都在受运动性帕金森症影响更严重的半球接受了单侧 DBS 植入。认知测量包括语言流畅性、听觉语言记忆和反应抑制。我们使用混合线性模型来比较定向刺激与环形刺激以及植入半球对纵向认知功能的影响。结果交叉分析显示，没有证据表明与定向刺激与环形刺激相关的认知表现在群体水平发生变化。然而，植入半球以多种方式影响认知。左侧 STN 参与者的基线语言流畅度低于右侧植入物患者（t[20.66 = −2.50,p= 0.02]）。离开后言语流畅度下降（p= 0.013) 但在右 STN DBS 后增加 (p< 0.001)，右 STN DBS 后反应抑制更快（p= 0.031）。无论大脑半球如何，延迟回忆随时间的推移与基线相比略有下降（p= 0.001），并且即时回忆没有变化。 解释定向与环形 STN DBS 对认知的影响没有差异。与之前的双边 DBS 研究类似，单侧左侧刺激使言语流畅性表现恶化。相比之下，单侧右侧 STN 手术提高了语言流畅性和反应抑制任务的表现。我们的研究结果提出了这样的假设：对选定的右脑运动性帕金森病为主的患者进行单侧右侧 STN DBS 可以减轻与双侧干预相关的言语流畅性下降。安神经学 2024