| PART ONE Neuropsychiatric effects of subthalamic nucleus deep brain stimulation on patients with Parkinson's diseaseObjective Parkinson's disease(PD)is a common neurodegenerative disease and usually shows neuropsychiatric disorders.The present prospectively controlled study investigated the changes before and after subthalamic nucleus deep brain stimulation(STN-DBS)in cognition,anxiety,depression,motor abilities,activity of daily life,disease stage,surgical complications and medicine dosage,hoping to provide novel guidance to clinical practice.Methods The present small-sample cohort study recruited 42 PD patients at Zhongnan hospital of Wuhan University,who were divided into DBS group(n=21,patients receiving STN-DBS and anti-parkisonism drug)and control group(n=21,patients receiving anti-parkinsonism drug only).They were assessed at both baseline and 6-month follow-up with Unified Parkinson Disease Rating Scale(psychiatry,behavior,emotion,activity of daily life,motor symptoms,drug complications),Addenbrooke's Cognitive Examination-Revised(orientation and attention,memory,verbal fluency,language and visuospatial ability),Hoehn-Yahr stage(disease stage),Schwab-England activity of daily life(activity of daily life),Hamilton anxiety scale(anxiety)and Hamilton depression scale(depression)under medication-on/stimulation-on condition.Comparison of changes between baseline and follow-up in each group used paired-t test or Wilcoxon signed rank test.Comparison of changes between the two groups used independent-t test or Mann-Whitney rank test.Results Compared with baseline data,patients in DBS group suffered a significant decrease in verbal fluency(p=0.022),with no significant changes in global cognition as well as improvements in motor symptoms(p=0.004),depression(p=0.007)and anxiety(p=0.001)during 6-month follow-up.The dose of anti-parkinsonism drug decreased significantly(p=0.001).Compared with dopaminergic therapy,STN-DBS contributes to improvements in motor symptoms(p=0.000),activity of daily life(p=0.047),depression(p=0.009),anxiety(p=0.003)as well as less anti-parkinsonism drug(p=0.000).Conclusion STN-DBS is relatively safe for PD patients with respect to cognition.Considering the improvement in depression,anxiety,activity of daily life and motor abilities,our study should give physicians positive guidance towards surgery treatment of advanced PD patients.PART TWOThe influence of subthalamic nucleus deep brain stimulation on cognition in a rat model of Parkinson's diseaseObjective This part aimed to use the rat model of PD to investigate the cognitive changes,i.e.the spatial learning and memory,after STN-DBS and the role of Acetylcholine(Ach)during this process.Methods 30 healthy male Sprague-Dawley rats were randomly divided into 3 groups:control group(n=10,injection of 0.9%saline into the right medial forebrain bundle,i.e.MFB),model group(n=10,injection of 6-OHDA into the right MFB),and stimulation group(n=10,injection of 6-OHDA into the right MFB,with STN-DBS).The cognitive function of rats were tested through Morris water maze and Ach levels in cortex,hippocampus and striatum were examined through enzyme linked immunosorbent assay.Results PD rats suffered a decline in the spatial learning and memory compared with healthy ones(p<0.05),which could be restored by STN-DBS.Similar results demonstrated that the expression of Ach in hippocampus and striatum was significantly lower in PD rats than those in healthy rats(p<0.05),and STN-DBS treatment reversed this decline to insignificant.Cortex Ach level didn't differ among three groups.Conclusion The rat model of PD suffered from a decline in cognition,and STN-DBS contributed to cognitive recovery,possibly due to regulating Ach levels in cognition-associated regions of the brain,including hippocampus and striatum. |
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