Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: The COMPARE Trial

Objective Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease. Methods Fifty‐two subjects were randomized to unilateral STN or GPi DBS. The co‐primary out...

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Published in	Annals of neurology Vol. 65; no. 5; pp. 586 - 595
Main Authors	Okun, Michael S., Fernandez, Hubert H., Wu, Samuel S., Kirsch-Darrow, Lindsey, Bowers, Dawn, Bova, Frank, Suelter, Michele, Jacobson IV, Charles E., Wang, Xinping, Gordon Jr, Clifford W., Zeilman, Pam, Romrell, Janet, Martin, Pam, Ward, Herbert, Rodriguez, Ramon L., Foote, Kelly D.
Format	Journal Article
Language	English
Published	Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.05.2009 Wiley-Liss
Subjects	Adult Aged Biological and medical sciences Cognition Disorders - etiology Cognition Disorders - therapy Deep Brain Stimulation - methods Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Double-Blind Method Electric Stimulation - methods Female Globus Pallidus - physiology Humans Male Medical sciences Middle Aged Mood Disorders - etiology Mood Disorders - therapy Motor Activity - physiology Neurology Neuropsychological Tests Parkinson Disease - complications Parkinson Disease - therapy Prospective Studies Psychiatric Status Rating Scales Subthalamic Nucleus - physiology Nervous system diseases Deep brain stimulation Central nervous system Parkinson disease Cognition Encephalon Cerebral disorder Mood Central nervous system disease Degenerative disease Subthalamic nucleus Comparative study Extrapyramidal syndrome
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Abstract	Objective Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease. Methods Fifty‐two subjects were randomized to unilateral STN or GPi DBS. The co‐primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post‐DBS in the optimal setting compared to pre‐DBS. At 7 months post‐DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS). Results Forty‐five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co‐primary mood and cognitive outcomes pre‐ to post‐DBS in the optimal setting (Hotelling's T2 test: p = 0.16 and 0.08 respectively). Subjects in both targets were less “happy”, less “energetic” and more “confused” when stimulated ventrally. Comparison of the other 3 DBS conditions to pre‐DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets. Interpretation There were no significant differences in the co‐primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation‐induced effect. Similar motor improvement were observed with both STN and GPi DBS. Ann Neurol 2009
AbstractList	Objective Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease. Methods Fifty‐two subjects were randomized to unilateral STN or GPi DBS. The co‐primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post‐DBS in the optimal setting compared to pre‐DBS. At 7 months post‐DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS). Results Forty‐five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co‐primary mood and cognitive outcomes pre‐ to post‐DBS in the optimal setting (Hotelling's T2 test: p = 0.16 and 0.08 respectively). Subjects in both targets were less “happy”, less “energetic” and more “confused” when stimulated ventrally. Comparison of the other 3 DBS conditions to pre‐DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets. Interpretation There were no significant differences in the co‐primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation‐induced effect. Similar motor improvement were observed with both STN and GPi DBS. Ann Neurol 2009 Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease.OBJECTIVEOur aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease.Fifty-two subjects were randomized to unilateral STN or GPi DBS. The co-primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post-DBS in the optimal setting compared to pre-DBS. At 7 months post-DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS).METHODSFifty-two subjects were randomized to unilateral STN or GPi DBS. The co-primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post-DBS in the optimal setting compared to pre-DBS. At 7 months post-DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS).Forty-five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co-primary mood and cognitive outcomes pre- to post-DBS in the optimal setting (Hotelling's T(2) test: p = 0.16 and 0.08 respectively). Subjects in both targets were less "happy", less "energetic" and more "confused" when stimulated ventrally. Comparison of the other 3 DBS conditions to pre-DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets.RESULTSForty-five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co-primary mood and cognitive outcomes pre- to post-DBS in the optimal setting (Hotelling's T(2) test: p = 0.16 and 0.08 respectively). Subjects in both targets were less "happy", less "energetic" and more "confused" when stimulated ventrally. Comparison of the other 3 DBS conditions to pre-DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets.There were no significant differences in the co-primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation-induced effect. Similar motor improvement were observed with both STN and GPi DBS.INTERPRETATIONThere were no significant differences in the co-primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation-induced effect. Similar motor improvement were observed with both STN and GPi DBS. Objective Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease. Methods Fifty-two subjects were randomized to unilateral STN or GPi DBS. The co-primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post-DBS in the optimal setting compared to pre-DBS. At 7 months post-DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS). Results Forty-five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co-primary mood and cognitive outcomes pre- to post-DBS in the optimal setting (Hotelling's T2 test: p = 0.16 and 0.08 respectively). Subjects in both targets were less happy, less energetic and more confused when stimulated ventrally. Comparison of the other 3 DBS conditions to pre-DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets. Interpretation There were no significant differences in the co-primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation-induced effect. Similar motor improvement were observed with both STN and GPi DBS. Ann Neurol 2009. Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain stimulation (DBS) in Parkinson disease. Fifty-two subjects were randomized to unilateral STN or GPi DBS. The co-primary outcome measures were the Visual Analog Mood Scale, and verbal fluency (semantic and letter) at 7 months post-DBS in the optimal setting compared to pre-DBS. At 7 months post-DBS, subjects were tested in four randomized/counterbalanced conditions (optimal, ventral, dorsal, and off DBS). Forty-five subjects (23 GPi, 22 STN) completed the protocol. The study revealed no difference between STN and GPi DBS in the change of co-primary mood and cognitive outcomes pre- to post-DBS in the optimal setting (Hotelling's T(2) test: p = 0.16 and 0.08 respectively). Subjects in both targets were less "happy", less "energetic" and more "confused" when stimulated ventrally. Comparison of the other 3 DBS conditions to pre-DBS showed a larger deterioration of letter verbal fluency in STN, especially when off DBS. There was no difference in UPDRS motor improvement between targets. There were no significant differences in the co-primary outcome measures (mood and cognition) between STN and GPi in the optimal DBS state. Adverse mood effects occurred ventrally in both targets. A worsening of letter verbal fluency was seen in STN. The persistence of deterioration in verbal fluency in the off STN DBS state was suggestive of a surgical rather than a stimulation-induced effect. Similar motor improvement were observed with both STN and GPi DBS.
Author	Bowers, Dawn Kirsch-Darrow, Lindsey Zeilman, Pam Wu, Samuel S. Bova, Frank Okun, Michael S. Suelter, Michele Martin, Pam Jacobson IV, Charles E. Gordon Jr, Clifford W. Foote, Kelly D. Romrell, Janet Rodriguez, Ramon L. Fernandez, Hubert H. Wang, Xinping Ward, Herbert
Author_xml	– sequence: 1 givenname: Michael S. surname: Okun fullname: Okun, Michael S. email: okun@neurology.ufl.edu organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 2 givenname: Hubert H. surname: Fernandez fullname: Fernandez, Hubert H. organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 3 givenname: Samuel S. surname: Wu fullname: Wu, Samuel S. organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 4 givenname: Lindsey surname: Kirsch-Darrow fullname: Kirsch-Darrow, Lindsey organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 5 givenname: Dawn surname: Bowers fullname: Bowers, Dawn organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 6 givenname: Frank surname: Bova fullname: Bova, Frank organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 7 givenname: Michele surname: Suelter fullname: Suelter, Michele organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 8 givenname: Charles E. surname: Jacobson IV fullname: Jacobson IV, Charles E. organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 9 givenname: Xinping surname: Wang fullname: Wang, Xinping organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 10 givenname: Clifford W. surname: Gordon Jr fullname: Gordon Jr, Clifford W. organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 11 givenname: Pam surname: Zeilman fullname: Zeilman, Pam organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 12 givenname: Janet surname: Romrell fullname: Romrell, Janet organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 13 givenname: Pam surname: Martin fullname: Martin, Pam organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 14 givenname: Herbert surname: Ward fullname: Ward, Herbert organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 15 givenname: Ramon L. surname: Rodriguez fullname: Rodriguez, Ramon L. organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL – sequence: 16 givenname: Kelly D. surname: Foote fullname: Foote, Kelly D. organization: Movement Disorders Center, University of Florida, McKnight Brain Institute, College of Medicine, Gainesville, FL
BackLink	http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21557255$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/19288469$$D View this record in MEDLINE/PubMed
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Keywords	Nervous system diseases Deep brain stimulation Central nervous system Parkinson disease Cognition Encephalon Cerebral disorder Mood Central nervous system disease Degenerative disease Subthalamic nucleus Comparative study Extrapyramidal syndrome
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Notes	Potential conflict of interest: This study was industry independent and completely supported by the NIH. M.S.O serves as a consultant to the National Parkinson Foundation (National Medical Director), and K.D.F. and M.S.O. receive honoraria for DBS fellows and for physician teaching from the Medtronic company. istex:2141B2BB9FCAC7CE59D2B44FB021AAA0FFC116FB ark:/67375/WNG-3G7QSZ2C-8 ArticleID:ANA21596 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 ObjectType-Undefined-3
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Parkinsonism Relat Disord 2004; 10: 247-251. 2002; 59 2002; 97 2002; 79 2005; 62 2002; 1 1999; 340 1992; 149 1999; 45 2004; 3 2006; 18 2005; 43 2003; 18 1992; 55 2003; 74 2007; 13 2001; 345 1998; 44 1998; 88 2004; 10 2004; 55 2004; 75 2006; 20 1986; 143 1993; 50 1989; 146 2006; 21 2006; 66 1997; 185 2005; 103 2000; 55 2005; 128 2005; 96 2007; 7 2000; 123 1992; 42 2007; 318 2007; 22 e_1_2_6_31_2 e_1_2_6_30_2 e_1_2_6_18_2 e_1_2_6_19_2 e_1_2_6_12_2 e_1_2_6_35_2 e_1_2_6_13_2 e_1_2_6_34_2 e_1_2_6_10_2 e_1_2_6_33_2 e_1_2_6_11_2 e_1_2_6_32_2 e_1_2_6_16_2 e_1_2_6_39_2 e_1_2_6_17_2 e_1_2_6_38_2 e_1_2_6_37_2 e_1_2_6_15_2 e_1_2_6_36_2 e_1_2_6_20_2 e_1_2_6_41_2 e_1_2_6_40_2 Rodriguez RL (e_1_2_6_14_2) 2005; 96 e_1_2_6_8_2 e_1_2_6_7_2 e_1_2_6_9_2 e_1_2_6_29_2 e_1_2_6_4_2 e_1_2_6_3_2 e_1_2_6_6_2 e_1_2_6_5_2 e_1_2_6_24_2 e_1_2_6_23_2 e_1_2_6_2_2 e_1_2_6_22_2 e_1_2_6_21_2 e_1_2_6_28_2 e_1_2_6_27_2 e_1_2_6_26_2 e_1_2_6_25_2
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Snippet	Objective Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi)... Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi) deep brain... Objective Our aim was to compare in a prospective blinded study the cognitive and mood effects of subthalamic nucleus (STN) vs. globus pallidus interna (GPi)...
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SubjectTerms	Adult Aged Biological and medical sciences Cognition Disorders - etiology Cognition Disorders - therapy Deep Brain Stimulation - methods Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Double-Blind Method Electric Stimulation - methods Female Globus Pallidus - physiology Humans Male Medical sciences Middle Aged Mood Disorders - etiology Mood Disorders - therapy Motor Activity - physiology Neurology Neuropsychological Tests Parkinson Disease - complications Parkinson Disease - therapy Prospective Studies Psychiatric Status Rating Scales Subthalamic Nucleus - physiology
Title	Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: The COMPARE Trial
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