Different outcomes of phonemic verbal fluency in Parkinson’s disease patients with subthalamic nucleus deep brain stimulation (original) (raw)
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European Journal of Neurology, 2012
Background and purpose: Despite common occurrences of verbal fluency declines following bilateral subthalamic nucleus deep brain stimulation (STN-DBS) for the treatment of Parkinson's disease (PD), alternating fluency measures using cued and uncued paradigms have not been evaluated. Methods: Twenty-three STN-DBS patients were compared with 20 non-surgical (PD) patients on a comprehensive neuropsychological assessment, including cued and uncued intradimensional (phonemic/phonemic and semantic/semantic) and extra-dimensional (phonemic/semantic) alternating fluency measures at baseline and 6-month follow-up. Results: STN-DBS patients demonstrated a greater decline on the cued phonemic/ phonemic fluency and the uncued phonemic/semantic fluency tasks as compared to the PD patients. For STN-DBS patients, verbal learning and information processing speed accounted for a significant proportion of the variance in declines in alternating phonemic/phonemic and phonemic/semantic fluency scores, respectively, whilst only naming was related to uncued phonemic/semantic performance for the PD patients. Both groups were aided by cueing for the extra-dimensional task at baseline and follow-up, and the PD patients were also aided by cueing for the phonemic/phonemic task on follow-up. Conclusions: These findings suggest that changes in alternating fluency are not related to disease progression alone as STN-DBS patients demonstrated greater declines over time than the PD patients, and this change was related to declines in information processing speed.
Journal of Parkinson's Disease, 2018
Background: Subthalamic Deep Brain Stimulation (STN-DBS) is an established treatment for late stage Parkinson's disease (PD). Speech intelligibility (SI) and verbal fluency (VF) have been shown to deteriorate following chronic STN-DBS. It has been suggested that speech might respond favourably to low frequency stimulation (LFS). Objective: We examined how speech intelligibility, perceptual speech characteristics, phonemic and semantic VF and processes underlying it (clustering and switching) respond to LFS of 60 and 80Hz in comparison to high frequency stimulation (HFS) (110, 130 and 200 Hz). Methods: In this double-blind study, 15 STN-DBS PD patients (mean age 65, SD=5.8, 14 right handed, three females), were assessed at five stimulation frequencies: 60Hz, 80Hz, 110Hz, 130Hz and 200Hz. In addition to the clinical neurological assessment of speech, VF and SI were assessed. Results: Speech intelligibility and in particular articulation, respiration, phonation and prosody improved with LFS (all p<0.05). Phonemic VF switching improved with LFS (p=0.005) but this did not translate to an improved phonemic VF score. A trend for improved semantic VF was found. A negative correlation was found between perceptual characteristics of speech and duration of chronic stimulation (all p<0.05). Conclusions: These findings highlight the need for meticulous programming of frequency to maximise speech intelligibility in chronic STN-DBS. The findings further implicate stimulation frequency in changes to specific processes underlying VF, namely phonemic switching and demonstrate the potential to address such deficits through advanced adjustment of stimulation parameters.
Movement Disorders Clinical Practice, 2015
Background: DBS is commonly used to treat Parkinson's disease (PD). DBS is not considered to cause major cognitive side effects, but some research groups have reported that it can cause decreased verbal fluency. The influence of age on DBS cognitive outcome is unclear. We investigated the possible influence of patients' age, level of education, disease duration, disease progression, depression, and levodopa equivalent dose (LED) on verbal fluency performance in patients with PD who underwent DBS of the subthalamic nucleus (STN-DBS). In this article, we investigated the influence of demographic and clinical parameters, especially age, on cognitive performance post-DBS in PD patients. Methods: Forty-three patients with PD and without major psychiatric illness (according to Diagnostic and Statistical Manual of Mental Disroders, Fourth Edition) were enrolled in the study. Median age was 64.0 years (range, 46-77). In 21 patients, the indication for DBS was established on clinical grounds in keeping with international guidelines; these patients underwent STN-DBS, and the remaining 22 did not. Cognitive performance in both groups was assessed by standard neuropsychological test batteries at baseline and after median follow-up of 7 months. Results: A statistically significant decline in the semantic category of verbal fluency task was found in the STN-DBS group (P < 0.01). Linear regression model revealed an influence of age (P < 0.01) and disease duration (P < 0.01) in relation to this decline. Conclusions: This study confirms previous findings that verbal fluency declines after STN-DBS in PD patients in comparison to PD patients without DBS. This decline is related to age and disease duration.
Movement Disorders, 2014
Speech changes after bilateral subthalamic nucleus deep brain stimulation (STN-DBS) can be variable, with the majority of patients experiencing speech deterioration over time. The aim of this study was to describe the perceptual characteristics of speech following chronic STN-DBS and to analyze clinical and surgical factors that could predict speech change. Fiftyfour consecutive patients (34 men; mean age 6 standard deviation (SD), 58.8 6 6.3 years; mean 6 SD disease duration, 12.5 6 4.7 years; mean 6 SD levodopa equivalent, 1556 6 671 mg/day; mean 6 SD Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) offmedication score, 48.1 6 17.9 [range, 20-89]; and mean 6 SD UPDRS-III on-medication score, 12.4 6 7.8 [range, 2-31]) participated in this study. They were assessed before and at 1 year after surgery using the Assessment of Intelligibility for the Dysarthric Speech, the perceptual scale from Darley et al., and the UPDRS-III. Speech intelligibility deteriorated on average by 14.4% (P 5 0.0006
Worsening of Verbal Fluency After Deep Brain Stimulation in Parkinson's Disease: A Focused Review
Computational and structural biotechnology journal, 2017
Worsening of verbal fluency after treatment with deep brain stimulation in Parkinson's disease patients is one of the most often reported cognitive adverse effect. The underlying mechanisms of this decline are not well understood. The present focused review assesses the evidence for the reliability of the often-reported decline of verbal fluency, as well as the evidence for the suggested mechanisms including disease progression, reduced medication levels, electrode positions, and stimulation effect vs. surgical effects. Finally, we highlight the need for more systematic investigations of the large degree of heterogeneity in the prevalence of verbal fluency worsening after DBS, as well as provide suggestions for future research.
Long-term effects of subthalamic nucleus deep brain stimulation on speech in Parkinson’s disease
Scientific Reports, 2023
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment in advanced Parkinson's Disease (PD). However, the effects of STN-DBS on speech are still debated, particularly in the long-term follow-up. The objective of this study was to evaluate the long-term effects of bilateral STN-DBS on speech in a cohort of advanced PD patients treated with bilateral STN-DBS. Each patient was assessed before surgery through a neurological evaluation and a perceptual-acoustic analysis of speech and reassessed in the long-term in different stimulation and drug conditions. The primary outcome was the percentage change of speech intelligibility obtained by comparing the postoperative on-stimulation/off-medication condition with the preoperative off-medication condition. Twentyfive PD patients treated with bilateral STN-DBS with a 5-year follow-up were included. In the longterm, speech intelligibility stayed at the same level as preoperative values when compared with preoperative values. STN-DBS induced a significant acute improvement of speech intelligibility (p < 0.005) in the postoperative assessment when compared to the on-stimulation/off-medication and off-stimulation/off-medication conditions. These results highlight that STN-DBS may handle speech intelligibility even in the long-term. Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) represents a short and long-term effective treatment in advanced Parkinson's Disease (PD) 1,2. However, the long-term effects of bilateral STN-DBS on axial features 3,4 and different speech variables are still debated. After surgery, PD patients may develop heterogeneous profiles of dysarthria related to the possible spreading of current to cerebellothalamic, cortico-bulbar, corticospinal and pallido-fugal levels 5,6. Moreover, it has been previously reported that speech intelligibility may worsen 1 year after surgery when compared with those under a control group under optimal medical treatment 7. The majority of the studies regarding the effects of STN-DBS on speech focused on short-term follow-up 7-11 while few studies have assessed the long-term effects 2,12-14. In particular, a previous study reported a worsening of speech intelligibility at five and eight years after surgery in the off-medication condition 12 , while another acoustic study reported variation of the long-term averaged spectrum (LTAS) descriptors for reading and monologue in different stimulation conditions in the long-term after surgery 14. The objective of this study was to evaluate
Parkinsonism & Related Disorders, 2006
A decline in verbal fluency is the most consistent neuropsychological sequela of deep brain stimulation (DBS) for Parkinson's disease. We assessed clinical correlates and switching and clustering subcomponents in 26 parkinsonians undergoing subthalamic DBS. Post-surgical motor improvement was accompanied by worsening at both letter and category fluency tasks. Total number of words and switches decreased, while average cluster size was unchanged. Worsening tended to be prominent in patients with baseline poorer cognitive status and more depressed mood. Impairment of shifting suggests prefrontal dysfunction, possibly due to disruption of fronto-striatal circuits along the surgical trajectory and/or to high frequency stimulation itself. q
Journal of medical speech-language pathology, 2006
This study tested the hypothesis that left versus right deep brain stimulation (DBS) of the subthalamic nucleus (STN) would have differential effects on speech. Twenty right-handed individuals with advanced Parkinson's disease (PD) underwent unilateral STN DBS. Ten were operated on the right and 10 on the left hemisphere as indicated by severity of nonspeech motor function. Speech was evaluated before surgery and 3 to 6 months after surgery with stimulator-off and with stimulator-on, with all participants off anti-parkinsonian medication for 12 hours before evaluation. Evaluators and patient speakers were blinded to the stimulator status at the postsurgery evaluations. Motor performance was assessed with UPDRS-III. Each participant produced three samples of diadochokinetic syllables. Syllable rate, syllable and vowel duration, VOT, and F0 were obtained. The diadochokinetic syllables were rated for articulatory accuracy and speaking rate. Twenty graduate clinicians served as judg...
2019
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an effective and widely used tool in the treatment of Parkinson’s disease (PD). STN-DBS has varied effects on speech. Clinical speech ratings suggest worsening following STN-DBS, but quantitative intelligibility, perceptual, and acoustic studies have produced mixed and inconsistent results. Improvements in phonation and declines in articulation have frequently been reported during different speech tasks under different stimulation conditions. Questions remain about preferred STN-DBS stimulation settings. Seven right-handed, native speakers of English with PD treated with bilateral STN-DBS were studied off medication at three stimulation conditions: stimulators off, 60 Hz (low frequency stimulation - LFS), and the typical clinical setting of 185 Hz (High frequency - HFS). Spontaneous speech was recorded in each condition and excerpts were prepared for transcription (intelligibility) and difficulty judgements. Se...