| Backgroud: Background: Parkinson’s disease(PD)is a degenerative disease,and the initial treatment is mainly oral drugs.Due to the limitations and side effects of drugs,a reversible and adjustable surgical treatment method has been widely used in clinical practice.The DBS treatment is currently considered to be the second major breakthrough in PD treatment since the introduction of levodopa.DBS can improve the motor symptoms of patients,but the impact on some non-motor symptoms is not very clear,and we need to continue to explore further.Cognitive dysfunction is one of the most disabling non-motor symptoms of Parkinson’s disease,including PD mild cognitive impairment(mild cognitive impairment in PD,PD-MCI)and PD dementia.Studies have found that the prevalence of PD-MCI is as high as40%,and long-term follow-up studies show that about 80% of patients with advanced PD will develop PD dementia.Currently,dementia is considered a contraindication for STN-DBS,so it is worthwhile exploring whether DBS further aggravates cognitive impairment in PD-MCI.Neuropsychological evaluation is an important tool for PD-MCI diagnosis,in which cognitive function test can provide objective evidence for the degree of cognitive impairment in PD-MCI.As a neuroimaging technology,f NIRS is widely used in the field of neuroscience.f NIRS can overcome PD’s tremors,limb movement disorders and the compatibility problems of postoperative metal implants,and can better observe the hemodynamic changes caused by neurovascular coupling in patients,which is especially suitable for patients after DBS.At present,the combination of functional near-infrared spectroscopy(f NIRS)and verbal fluency test(VFT)has become a convenient and rapid method to check for mental illness.Therefore,this study is based on the neuropsychological assessment,clinical scale,and f NIRS technology to study the effect of STN-DBS on the postoperative cognitive of PD-MCI patients,and to explore the changes of the neural mechanism in the cerebral cortical circuit.Because MCI patients in PD are more likely to develop dementia with disease progression,it is necessary to understand which cognitive function is impaired in this disease after DBS implantation,so as to conduct early screening and treatment.Objective: To explore the cognitive changes in STN-DBS,and to provide a clinical basis for the selection of appropriate surgical patients for STN-DBS.Methods:Ten PD-MCI patients who underwent STN-DBS were selected in The first affiliated hospital of Dalian Medical University as participants.The researcher collected and recorded these patients’ general information after admission from November 2021 to September 2022.10 PD-MCI patients were evaluated using the motor part(UPDRSIII)of the Unified Parkinson’s Disease Score Scale,Montreal Cognitive Assessment Scale(Mo CA),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),five cognitive domains(executive,language,visual space,attention and memory function)at 1 week before surgery,1 month after surgery,and 3 months after surgery with STN-DBS.At the same time,the f NIRS technique was used to record the changes of the brain activation and low-frequency fluctuation amplitude(ALFF)in resting state during the verbal fluency task in PD-MCI patients 1 week before surgery,one week after startup,and 3 months after surgery.The startup time is 1 month after the operation,which will cause disorders to the patient’s brain,so we choose to evaluate the patient 1 week after the startup.Results:1.The updrs-III score was statistically significant(P<0.01),which demonstrated the improvement in motor symptoms.Meanwhile,MMSE and Mo Ca scores were improved compared with preoperative scores(P>0.05),but they were not statistically significant.HAMD score deteriorated one week after startup,with statistical differences(P<0.01),and decreased one week to three months after startup(P>0.05).Overall,HAMD scores tended to be statistically significant(P=0.02).The HAMA score decreased statistically significantly in one week after startup(P<0.05),and also decreased by 3months after surgery.2.The patient had a significant decrease in speech fluency and classification fluency one week after surgery(P<0.05),and had a recovery trend at 3 months after surgery,but it was not statistically significant before and one week after surgery.Both postoperative visual space and attention were improved than previously,but not statistically significant(P>0.05).Memory scores decreased postoperative but not statistically significant(P>0.05).3.There was a statistically significant decrease(P<0.05),and a trend of recovery occurred at 3 months after surgery.Three-month NIR functional brain imaging showed an increase in oxyhemoglobin levels in the dorsolateral prefrontal and orbitofrontal cortex,but no significant statistical difference.Conclusion: After STN-DBS surgery,the patient showed a temporary decline in executive function,which tended to improve with time.On the contrary,visual space and attention were improved.What’s more,STN-DBS had a slight negative impact on memory and which continues to decline.Overall,STN-DBS can improve PD-MCI patients’ motor symptoms,but had no significant effect on the cognitive condition,and it improved the patient’s motor symptoms. |
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