Comparative cognitive effects of bilateral subthalamic stimulation and subcutaneous continuous infusion of apomorphine in Parkinson's disease

Authors

  • Montse Alegret PhD,

    1. Parkinson's Disease and Movement Disorders Unit, Service of Neurology, Institut de Malalties del Sistema Nerviós, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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  • Francesc Valldeoriola MD,

    Corresponding author
    1. Parkinson's Disease and Movement Disorders Unit, Service of Neurology, Institut de Malalties del Sistema Nerviós, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
    • Service of Neurology, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
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  • MaJosé Martí MD,

    1. Parkinson's Disease and Movement Disorders Unit, Service of Neurology, Institut de Malalties del Sistema Nerviós, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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  • Manuela Pilleri MD,

    1. Parkinson's Disease and Movement Disorders Unit, Service of Neurology, Institut de Malalties del Sistema Nerviós, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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  • Carme Junqué PhD,

    1. Department of Psychiatry and Clinical Psychobiology, IDIBAPS, University of Barcelona, Barcelona, Spain
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  • Jordi Rumià MD,

    1. Service of Neurosurgery, Institut de Malalties del Sistema Nerviós, Hospital Clínic, University of Barcelona, Barcelona, Spain
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  • Eduardo Tolosa MD

    1. Parkinson's Disease and Movement Disorders Unit, Service of Neurology, Institut de Malalties del Sistema Nerviós, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Abstract

Bilateral subthalamic deep brain stimulation (STN-DBS) and continuous subcutaneous infusion of apomorphine (APM-csi) can provide a comparable improvement on motor function in patients with advanced Parkinson's disease (PD), but the mechanisms by which both therapies exert their effects are different. We analyzed the cognitive effects of APM-csi. We also compared neuropsychological effects induced by STN-DBS and APM-csi in advanced PD to ascertain the neuropsychological aspects relevant in determining the therapeutic procedure that is the most appropriate in a particular patient. We studied 9 patients treated with STN-DBS and 7 patients with APM-csi. Neuropsychological measures included Rey's Auditory-Verbal Learning, Stroop, Trail Making, phonetic verbal fluency, and Judgment of Line Orientation tests. In the APM-csi group, significant changes were not observed in the neuropsychological tests performance. By contrast, in the STN-DBS group, moderate worsening was found in phonetic verbal fluency and Stroop Naming scores that was partially reversible at long-term follow-up and did not have consequences on regular activities. Consequently, these findings could be interpreted as being not relevant in deciding the most suitable treatment in a given patient. © 2004 Movement Disorder Society

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