REVIEWS  PARKINSON’S DISEASE 

Minerva Psichiatrica 2009 March;50(1):79-92

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Cognitive and mood effects of subthalamic deep brain stimulation in Parkinson’s disease

Tröster A. I.

Department of Neurology University of North Carolina School of Medicine Chapel Hill, NC, USA

Deep brain stimulation (DBS) for Parkinson’s disease (PD) has come into increasing use since the 1990s. Thalamic and pallidal stimulation were the early treatments evaluated, but subthalamic (STN) DBS is the most commonly used treatment now and has received the most empirical attention. This article reviews the cognitive and mood alterations after STN DBS for PD and the possible etiology, risk factors, and mechanisms underlying neurobehavioral changes. In the majority of patients DBS is both effective and safe but, DBS may entail cognitive and psychiatric adverse events in about 10% of patients. Cognitive alterations (most commonly in verbal fluency) are typically transient, mild, and circumscribed. Rating and self-report scales typically reveal unaltered or improved mood state and a better quality of life after surgery. A minority of patients experience more widespread, persistent, or serious cognitive and psychiatric sequelae (including hypomania and depression), although research to date has not identified reliable risk factors for such adverse events. Recent data provide preliminary indication that risk of suicide is increased among DBS patients and that suicidal ideation and hopelessness should be carefully monitored after surgery.