Auswirkungen der tiefen Hirnstimulation auf neuropsychologische Funktionen bei Patienten mit Morbus Parkinson

Zusammenfassung

Diese Arbeit soll einen Überblick über die bisherigen Untersuchungen zu Auswirkungen der tiefen Hirnstimulation auf die neuropsychologischen Funktionen bei Patienten mit Morbus Parkinson geben: Die derzeit vorliegenden Studien konnten größtenteils keine signifikanten Effekte der tiefen Hirnstimulation auf die kognitiven Funktionen dieser Patientengruppe nachweisen. Leichte Veränderungen im Sinne von Verschlechterungen fanden sich vor allem in Bereichen der exekutiven Funktionen, der Wortflüssigkeit und des Gedächtnisses. Nur bei einzelnen Patienten wurde eine generelle massive Beeinträchtigung kognitiver Leistungen beobachtet. Es handelte sich dabei vor allem um Personen über 69 Jahre und bereits präoperativ kognitiv beeinträchtigte Patienten. Einige Studien berichten hingegen von Verbesserungen in Aspekten des Gedächtnisses, der Aufmerksamkeit sowie der exekutiven Funktionen. Da sich die vorliegenden Untersuchungen jedoch zumeist auf eine geringe Fallzahl und kurze Beobachtungszeiträume beziehen, können derzeit nur vorläufige Schlussfolgerungen gezogen werden. Für eine abschließende Bewertung der Auswirkungen der Stimulation auf kognitive Funktionen sind Langzeituntersuchungen mit einer größeren Anzahl von Patienten sowie der Vergleich der Ergebnisse mit einer Kontrollgruppe erforderlich. Notwendig ist auch die Berücksichtigung der Lateralität sowie der Stimulationsparameter. Die bisherigen Arbeiten zeigen, dass insgesamt nur eine geringe kognitive Morbidität bei gleichzeitig hoher Effizienz auf die motorischen Funktionen dieser Patientengruppe besteht, die somit den - kritischen - Einsatz dieser Methode rechtfertigt.

Abstract

This paper reviews the studies published so far evaluating the effects of chronic deep brain stimulation on neuropsychological functions in patients with Parkinson's disease. Most of the studies showed no significant changes after deep brain stimulation. Moderate deterioration was found in executive functions, verbal fluency and memory. A decline in overall level of cognitive functioning was only observed in few patients, who were older than 69 years and already mentally impaired before surgery. In contrast only a few studies reported improvement in memory, attention and executive function. Because most of the studies included a small number of patients and short follow-up periods, the results are preliminary. For a final evaluation of the effects of deep brain stimulation on cognitive functions further studies with long-term follow-up and larger number of patients as well as comparison of the results with a control group will be necessary. The side of implantation - if unilateral - and the parameters of stimulation should be taken into consideration. But so far deep brain stimulation can be considered as a method with high efficiency in improving motor functions and only slight cognitive changes in patients with Parkinson's disease.

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