行脑深部电刺激的帕金森病患者非运动症状预后的影响因素

Objective To investigate the effects of electrode activated contact location, volume of tissue activated (VTA) and age on non‑motor symptoms, such as emotional symptoms and cognitive function, in Parkinson′s disease (PD) patients with deep brain stimulation (DBS). Methods PD patients who underwent DBS of subthalamic nucleus (STN) at the Department of Functional Neurosurgery of Beijing Tiantan Hospital from September 1, 2020 to August 31, 2022 were retrospectively enrolled. The International Parkinson and Movement Disorder Society‑Unified Parkinson′s Disease Rating Scale (MDS‑UPDRS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), Montreal Cognitive Assessment (MoCA), and Mini‑Mental State Examination Scales (MMSE) were used at the preoperative, 1‑month and 12‑month postoperative time points. In this study, patients were divided into middle‑aged (age<60 years,n=39) and elderly (age≥60 years,n=62) groups to investigate the effect of age factor on the clinical outcome of surgery. Lead‑DBS software was used to convert the patients′ electrode reconstruction results into Montreal standard space, and the patients were divided into sensorimotor(n=43) and combined groups(n=53) according to the distribution of activation contact locations in the subzones of the STN. In addition, the patients were divided into a cognitive improvement group(n=57)and a cognitive deterioration group(n=44) based on the results of MoCA at 12 months. The positional information of the electrode activation contacts was collected and the VTA was calculated to analyze the effects on electrode activation electroshock location and activated tissue volume on patients′ non‑motor symptoms. Results A total of 101 patients with PD were enrolled, including 46 males and 55 females, aged (62.6±8.4) years. Middle‑aged patients had significantly higher MoCA scores, delayed recall scores, attention scores, and naming scores than older patients at 12 months postoperatively (all P<0.05). At 12‑month follow‑up, the improvement rate of MoCA score, HAMA score and HAMD score were -1.77%±20.36%, 39.65%±42.91% and 36.23%±45.45% respectively in sensorimotor group. At 12‑month follow‑up, the improvement rate of MoCA score, HAMA score and HAMD score was 11.69%±22.24%, 16.62%±68.10% and 2.30%±95.04% respectively in the combined group, and the difference between the two groups was statistically significant (MoCA: P=0.002; HAMA: P=0.040; HAMD: P=0.033) The distribution of VTA in the sensory motor area and marginal area of the left hemisphere STN in patients with improved cognitive function was significantly smaller than that in the deterioration group [(60.53±52.04)mm^3vs (84.55±61.00)mm³, P=0.035; (41.81±33.36)mm^3vs (59.05±45.46)mm³, P=0.030]. Conclusion The effect of STN‑DBS on emotional symptoms and cognitive function in PD patients is influenced by various factors and is closely related to the patient′s age, electrode activation contact location and VTA.