Cognitive and Psychiatric Effects of STN versus GPi Deep Brain Stimulation in Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials

BackgroundDeep 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.MethodsWe 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.ResultsSeven 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.ConclusionsA 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.背景：丘脑底核（subthalamic nucleus, STN）或内侧苍白球（globus pallidus interna, GPi）的脑深部电刺激（deep brain stimulation, DBS）可缓解帕金森病（Parkinson’s disease, PD）患者的运动症状，并改善其生活质量。然而，STN-DBS与GPi-DBS对认知功能及精神症状的影响仍存在争议。因此，本研究开展了此项荟萃分析以明确上述争议问题。 方法：本研究检索了PubMed、EMBASE及考克兰对照试验中心注册库（Cochrane Central Register of Controlled Trials）数据库，同时检索了包括在线临床试验注册平台及灰色文献在内的其他文献来源。文献检索完成后，由2名研究者独立开展文献筛选工作，以评估纳入试验的质量并提取相关数据。本研究的结局指标包括STN-DBS与GPi-DBS对多认知域、抑郁、焦虑及生活质量的影响。 结果：本项荟萃分析共纳入与4项随机对照试验（randomized controlled trial, RCT）相关的7篇文献，涉及521名受试者。与GPi-DBS相比，STN-DBS术后可导致特定认知域的功能下降，包括注意力、工作记忆与处理速度、语音流畅性、学习记忆及整体认知。但两组在生活质量及抑郁、焦虑等精神症状方面无显著差异。 结论：相较于GPi-DBS，STN-DBS术后可出现额叶-皮层下认知功能的选择性下降，这一点在PD患者DBS治疗的靶点选择中不容忽视。此外，与GPi-DBS相比，STN-DBS不会对抑郁、焦虑及生活质量产生影响。