脑深部电刺激治疗对帕金森病患者认知功能、抑郁和焦虑的影响

Effects of deep brain stimulation on the cognition, depression, and anxiety of patients with Parkinson's disease

摘要:

目的 探讨双侧丘脑底核脑深部电刺激治疗（STN-DBS）对帕金森病（PD）患者认知功能和抑郁、焦虑状态的影响。方法 连续收集16例拟行双侧STN-DBS的PD患者为实验组，在术前1周、术后1月和术后3月行认知功能、抑郁和焦虑状态评估。同期在门诊收集16例优化药物治疗的PD患者为对照组，在相同时间点行同样的神经心理量表评估。结果 实验组患者的MoCA评分与术前（20.69±4.33）相比，在术后1月（19.81±4.34）及术后3月（19.44±5.35）均有下降趋势，但差异无统计学意义（P>0.05）。实验组患者的抑郁症状与术前（23.56±14.60）相比，在术后1月（11.94±6.16）及术后3月（7.38±5.18）有明显改善（P<0.05）。实验组患者的焦虑症状与术前（22.13±6.11）相比，在术后1月（15.13±5.62）及术后3月（8.00±6.76）有明显改善（P<0.05）。抑郁焦虑的改善在任何时期均与UPDRS-Ⅲ无相关性（P>0.05）。结论 双侧STN-DBS治疗在术后3月时并不影响PD患者的总体认知功能，但各个认知域的改变需要更为详细的神经心理量表评估；双侧STN-DBS治疗在短期内可以显著改善PD患者的抑郁和焦虑症状，且抑郁和焦虑症状的改善与STN-DBS治疗后运动症状的改善无关。

Abstract:

Objective To investigate the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on the cognition, depression, and anxiety of patients with Parkinson's disease (PD).Methods Sixteen PD patients undergoing bilateral STN-DBS were consecutively enrolled as subjects and assigned to experimental group. The cognition, depression, and anxiety of the patients were evaluated at 1 week before surgery and 1 and 3 weeks after surgery. Sixteen PD patients undergoing optimized drug treatment within the same period were assigned to control group. The control group was evaluated by the same neuropsychological scales at the same time points as the experimental group.Results In the experimental group, the scores for Montreal Cognitive Assessment at 1 and 3 weeks after surgery were slightly lower than that at 1 week before surgery (19.81±4.34 vs 20.69±4.33, P>0.05; 19.44±5.35 vs 20.69±4.33, P>0.05); patients showed significant improvement in depression at 1 and 3 months after surgery (11.94±6.16 vs 23.56±14.60, P<0.05; 7.38±5.18 vs 23.56±14.60, P<0.05); patients also showed significant improvement in anxiety at 1 and 3 months after surgery (15.13±5.62 vs 22.13±6.11, P<0.05; 8.00±6.76 vs 22.13±6.11, P<0.05). The improvement in depression and anxiety was not correlated with UPDRS part Ⅲ at any time point.Conclusions Bilateral STN-DBS does not affect the global cognitive function of PD patients at 3 months after surgery. However, the changes in the cognitive domains require a more detailed assessment by the neuropsychological scales. Bilateral STN-DBS can significantly improve the depression and anxiety of PD patients in the short term.The improvemet of depression and anxiety was not correlated with the improvement of motor symtoms at any time points.