Effects of levodopa and subthalamic nucleus stimulation on cognitive and affective functioning in Parkinson's disease.

Full Abstract

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.

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Author information

Author/s: Funkiewiez, Aurélie (A); Ardouin, Claire (C); Cools, Roshan (R); Krack, Paul (P); Fraix, Valérie (V); Batir, Alina (A); Chabardès, Stephan (S); Benabid, Alim-Louis (AL); Robbins, Trevor W (TW); Pollak, Pierre (P);

Affiliation: Department of Clinical and Biological Neurosciences, University Hospital of Grenoble, and INSERM U318, Joseph Fourier University of Grenoble, Grenoble, France. a.funkiewiez(-atsign-)tiscali.fr

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Movement disorders : official journal of the Movement Disorder Society (Mov Disord), published in United States. (Language: eng)

Reference: 2006-Oct; vol 21 (issue 10) : pp 1656-62

Dates: Created 2006/10/26; Completed 2007/02/02;

PMID: 16830317, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Affect - drug effects; physiology
Antiparkinson Agents - therapeutic use
Cerebral Cortex - drug effects; physiopathology
Cognition - drug effects; physiology
Combined Modality Therapy
Corpus Striatum - drug effects; physiopathology
Deep Brain Stimulation
Depressive Disorder - physiopathology; therapy
Extinction, Psychological - drug effects; physiology
Female
Humans

Humans
Levodopa - therapeutic use
Male
Middle Aged
Motivation
Neural Pathways - drug effects; physiopathology
Neurologic Examination - drug effects
Neuropsychological Tests
Problem Solving - drug effects; physiology
Reversal Learning - drug effects; physiology
Subthalamic Nucleus - physiopathology

Associated Chemicals: Antiparkinson Agents (0) ; Levodopa (0)

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