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Modified DBS (deep brain stimulation) for a patient with PDD
In this German case report, a 71-year-old man with "slowly progressive Parkinson-dementia syndrome" was given DBS (deep brain stimulation) where electrodes were inserted into two places in the brain. The patient experienced improvement of cognitive functions.
Archives of Neurology. 2009 Jun;66(6):781-5.
Cognitive functions in a patient with Parkinson-dementia syndrome undergoing deep brain stimulation.
Freund HJ, Kuhn J, Lenartz D, Mai JK, Schnell T, Klosterkoetter J, Sturm V.
Institute for Neuroscience and Medicine (INM-7) and Forschungszentrum Juelich, International Neuroscience Institute, Hannover, Germany.
BACKGROUND: Dementia represents one of the most challenging health problems. Despite intense research, available therapies have thus far only achieved modest results. Deep brain stimulation (DBS) is an effective treatment option for some movement disorders and is under study for psychiatric applications. Recently, diencephalic DBS revealed selective effects on memory functions, another facet of subcortical DBS.
OBJECTIVE: To report a new DBS strategy for the modification of cognitive functions in a patient with severe Parkinson-dementia syndrome. DESIGN: Prospective study with double-blinded sham stimulation period. SETTING: Departments of Stereotaxy and Functional Neurosurgery and Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
PATIENT: A 71-year-old man with slowly progressive Parkinson-dementia syndrome. Intervention We inserted 2 electrodes into the nucleus basalis of Meynert in addition to electrodes in the subthalamic nucleus. Main Outcome Measure Improvement of cognitive functions.
RESULTS: Turning on the subthalamic nucleus electrodes improved motor symptoms but left cognitive performance almost unchanged. Turning on electrical stimulation of the nucleus basalis of Meynert resulted in markedly improved cognitive functions. The improvement in attention, concentration, alertness, drive, and spontaneity resulted in the patient's renewed enjoyment of former interests and enhanced social communication.
CONCLUSIONS: Such a broad effect on cognition is consistent with ample experimental evidence revealing that the nucleus basalis of Meynert provides cholinergic innervation to the cortical mantle, complemented by glutaminergic and gamma-aminobutyric acid-transmitting projections from the basal forebrain. These projections provide background tuning facilitating cortical operations. Furthermore, nucleus basalis of Meynert stimulation paired with sensory stimuli can accomplish persistent reorganization of specific processing modules. The improvements in cognitive and behavioral performance in our patient are likely to be related to the effects of stimulating residual cholinergic projections and cell bodies in the nucleus basalis of Meynert.
PubMed ID#: 19506141 (see pubmed.gov for this abstract, which is free, or a link to the article, for which there's a charge)
Here's one short excerpt from the introduction:
"Regarding the effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on cognitive functions, a randomized, multicenter study showed that STN-DBS does not reduce overall cognition but is associated with a selective decrease in frontal cognitive functions. Clear improvements in the cognitive state in patients with Parkinson disease dementia (PDD) have so far not been shown. We describe a new DBS strategy for the modification of cognitive functions by stimulating the nucleus basalis of Meynert (NBM) in addition to the STN in a patient with PDD."