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Effects of levodopa and subthalamic nucleus stimulation on cognitive and affective functioning in Parkinson's disease
Author(s) -
Funkiewiez Aurélie,
Ardouin Claire,
Cools Roshan,
Krack Paul,
Fraix Valérie,
Batir Alina,
Chabardès Stephan,
Benabid AlimLouis,
Robbins Trevor W.,
Pollak Pierre
Publication year - 2006
Publication title -
movement disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.352
H-Index - 198
eISSN - 1531-8257
pISSN - 0885-3185
DOI - 10.1002/mds.21029
Subject(s) - levodopa , apathy , parkinson's disease , psychology , deep brain stimulation , subthalamic nucleus , stimulation , cognition , neuroscience , physical medicine and rehabilitation , medicine , disease
In Parkinson's disease (PD), levodopa and subthalamic nucleus (STN) stimulation lead to major improvement in motor symptoms. Effects of both treatments on cognition and affective status are less well understood. Motor, cognitive, and affective symptoms may relate to the dysfunctioning of parallel cortico–striatal loops. The aim of this study was to assess cognition, behavior, and mood, with and without both treatments in the same group of PD patients. A group of 22 nondemented PD patients was included in this study. Patients were tested twice before surgery ( off and on levodopa) and twice 3 months after surgery (OFF and ON STN stimulation, off levodopa). Cognitive and affective effects of STN stimulation and levodopa had some common, but also different, effects. STN stimulation improved performance on the planning test, associated with the dorsolateral prefrontal cortex. However, the treatments had opposite effects on tests associated with the orbitofrontal cortex; specifically, levodopa impaired while STN stimulation improved performance on the extinction phase of a reversal/extinction task. Acutely, both treatments improved motivation and decreased fatigue and anxiety. On chronic treatment (3 months after surgery), depression improved, whereas apathy worsened 3 months after surgery. To conclude, there were significant but contrasting effects of levodopa and STN stimulation on cognition and affective functions. © 2006 Movement Disorder Society