Citation

Tröster AI. Minerva Psichiatr. 2009; 50(1): 79-92.

Copyright

(Copyright © 2009, Italian Society of Social Psychiatry, Publisher Edizioni Minerva Medica)

DOI

unavailable

PMID

unavailable

Abstract

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 neurobehavio-ral 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.

Language: en

Keywords

human; quality of life; suicidal ideation; depression; psychosis; patient safety; clinical trial; mood disorder; risk factor; hopelessness; Cognitive therapy; review; personality disorder; pathological gambling; cognitive defect; hallucination; anxiety disorder; neuropathology; dysphoria; hypomania; levodopa; Parkinson disease; mental instability; verbal behavior; anhedonia; brain depth stimulation; subthalamic nucleus; mood change; hypersexuality; Deep brain stimulation; therapy effect; Neurobehavioral manifestations; pallidotomy