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Cognitive and Psychiatric Effects of STN versus GPi Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials.
PLoS One. 2016; 11(6):e0156721.Plos

Abstract

BACKGROUND

Deep brain stimulation (DBS) of either the subthalamic nucleus (STN) or the globus pallidus interna (GPi) can reduce motor symptoms in patients with Parkinson's disease (PD) and improve their quality of life. However, the effects of STN DBS and GPi DBS on cognitive functions and their psychiatric effects remain controversial. The present meta-analysis was therefore performed to clarify these issues.

METHODS

We searched the PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Other sources, including internet-based clinical trial registries and grey literature sources, were also searched. After searching the literature, two investigators independently performed literature screens to assess the quality of the included trials and to extract the data. The outcomes included the effects of STN DBS and GPi DBS on multiple cognitive domains, depression, anxiety, and quality of life.

RESULTS

Seven articles related to four randomized controlled trials that included 521 participants were incorporated into the present meta-analysis. Compared with GPi DBS, STN DBS was associated with declines in selected cognitive domains after surgery, including attention, working memory and processing speed, phonemic fluency, learning and memory, and global cognition. However, there were no significant differences in terms of quality of life or psychiatric effects, such as depression and anxiety, between the two groups.

CONCLUSIONS

A selective decline in frontal-subcortical cognitive functions is observed after STN DBS in comparison with GPi DBS, which should not be ignored in the target selection for DBS treatment in PD patients. In addition, compared to GPi DBS, STN DBS does not affect depression, anxiety, and quality of life.

Authors+Show Affiliations

Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

27248139

Citation

Wang, Jia-Wei, et al. "Cognitive and Psychiatric Effects of STN Versus GPi Deep Brain Stimulation in Parkinson's Disease: a Meta-Analysis of Randomized Controlled Trials." PloS One, vol. 11, no. 6, 2016, pp. e0156721.
Wang JW, Zhang YQ, Zhang XH, et al. Cognitive and Psychiatric Effects of STN versus GPi Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials. PLoS One. 2016;11(6):e0156721.
Wang, J. W., Zhang, Y. Q., Zhang, X. H., Wang, Y. P., Li, J. P., & Li, Y. J. (2016). Cognitive and Psychiatric Effects of STN versus GPi Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials. PloS One, 11(6), e0156721. https://doi.org/10.1371/journal.pone.0156721
Wang JW, et al. Cognitive and Psychiatric Effects of STN Versus GPi Deep Brain Stimulation in Parkinson's Disease: a Meta-Analysis of Randomized Controlled Trials. PLoS One. 2016;11(6):e0156721. PubMed PMID: 27248139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive and Psychiatric Effects of STN versus GPi Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials. AU - Wang,Jia-Wei, AU - Zhang,Yu-Qing, AU - Zhang,Xiao-Hua, AU - Wang,Yun-Peng, AU - Li,Ji-Ping, AU - Li,Yong-Jie, Y1 - 2016/06/01/ PY - 2015/12/21/received PY - 2016/05/18/accepted PY - 2016/6/2/entrez PY - 2016/6/2/pubmed PY - 2017/7/19/medline SP - e0156721 EP - e0156721 JF - PloS one JO - PLoS One VL - 11 IS - 6 N2 - BACKGROUND: Deep brain stimulation (DBS) of either the subthalamic nucleus (STN) or the globus pallidus interna (GPi) can reduce motor symptoms in patients with Parkinson's disease (PD) and improve their quality of life. However, the effects of STN DBS and GPi DBS on cognitive functions and their psychiatric effects remain controversial. The present meta-analysis was therefore performed to clarify these issues. METHODS: We searched the PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials databases. Other sources, including internet-based clinical trial registries and grey literature sources, were also searched. After searching the literature, two investigators independently performed literature screens to assess the quality of the included trials and to extract the data. The outcomes included the effects of STN DBS and GPi DBS on multiple cognitive domains, depression, anxiety, and quality of life. RESULTS: Seven articles related to four randomized controlled trials that included 521 participants were incorporated into the present meta-analysis. Compared with GPi DBS, STN DBS was associated with declines in selected cognitive domains after surgery, including attention, working memory and processing speed, phonemic fluency, learning and memory, and global cognition. However, there were no significant differences in terms of quality of life or psychiatric effects, such as depression and anxiety, between the two groups. CONCLUSIONS: A selective decline in frontal-subcortical cognitive functions is observed after STN DBS in comparison with GPi DBS, which should not be ignored in the target selection for DBS treatment in PD patients. In addition, compared to GPi DBS, STN DBS does not affect depression, anxiety, and quality of life. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27248139/Cognitive_and_Psychiatric_Effects_of_STN_versus_GPi_Deep_Brain_Stimulation_in_Parkinson's_Disease:_A_Meta_Analysis_of_Randomized_Controlled_Trials_ L2 - https://dx.plos.org/10.1371/journal.pone.0156721 DB - PRIME DP - Unbound Medicine ER -