Einfluss der Tiefen Hirnstimulation des Nucleus subthalamicus auf exekutive Funktionen bei Patienten mit idiopathischem Parkinson-Syndrom unter Berücksichtigung von Apathie, Depressivität und Stimmung

Zusammenfassung

In der vorliegenden Studie untersuchten wir den Einfluss von Apathie, Depression und transienten Stimmungsveränderungen auf exekutive Leistungen im optimierten medizinischen Zustand und unter Stimulation-on- und -off-Bedingungen postoperativ an 33 Patienten mit fortgeschrittenem idiopathischem Parkinson-Syndrom mit erfolgter Tiefer Hirnstimulation (THS) im Nucleus subthalamicus (STN), 33 Patienten mit rein medikamentöser Behandlung und 34 gesunden Probanden. Im Vergleich zur klinischen und gesunden Kontrollgruppe wiesen THS-Patienten nicht nur schlechtere exekutive Leistungen, sondern auch vermehrte Symptome von Depression und Apathie auf. Apathiesymptome erklärten Unterschiede in der Interferenzanfälligkeit zwischen den Gruppen. Effekte der Stimulation auf die Interferenzanfälligkeit konnten auf einen Anstieg der Zustandsängstlichkeit im -off zurückgeführt werden. Die Berücksichtigung neuropsychiatrischer Symptome und akuter Stimmungsveränderungen ist ein wichtiger Aspekt bei der Beurteilung möglicher neuropsychologischer Leistungsdefizite der Parkinsonerkrankung und der THS.

Abstract

We investigated the moderating influence of apathy, depression and transient mood changes on executive functions under best medical treatment and under postoperative stimulation-on and -off conditions in a sample of 33 patients with Parkinson’s disease (PD) after deep brain stimulation of the subthalamic nucleus (STN), 33 PD patients with pharmacological treatment only and 34 healthy controls. In comparison to clinical and healthy control groups, DBS patients showed worse executive task performance and also more severe symptoms of depression and apathy. Apathy accounted for differences in stroop interference between groups. The effects of DBS on stroop interference were explained by increased state anxiety in the -off, so that DBS STN had no significant influence on test performance. Consideration of neuropsychiatric symptoms and acute mood changes is an important aspect when evaluating neuropsychological deficits in DBS patients.

Schlüsselwörter

Morbus Parkinson - tiefe Hirnstimulation - Nucleus subthalamicus - exekutive Funktionen - Apathie - Depression

Key words

Parkinson’s disease - deep brain stimulation - subthalamic nucleus - executive functions - apathy - depression

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