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NEUROLOGY 2009;72:42-49
© 2009 American Academy of Neurology

Frontal FDG-PET activity correlates with cognitive outcome after STN-DBS in Parkinson disease

E. Kalbe, PhD, J. Voges, MD, T. Weber, MD, M. Haarer, MSc, Psy, S. Baudrexel, MD, J. C. Klein, MD, J. Kessler, PhD, V. Sturm, MD, W. D. Heiss, MD and R. Hilker, MD

From the Departments of Neurology (E.K., T.W., M.H., J.K.) and Stereotaxy and Functional Neurosurgery (V.S.), University of Cologne; Department of Stereotactic Neurosurgery (J.V.), University of Magdeburg; Department of Neurology (S.B., J.C.K., R.H.), Goethe-University Frankfurt; and Max-Planck Institute for Neurological Research (W.D.H.), Cologne, Germany.

Address correspondence and reprint requests to Dr. Elke Kalbe, Department of Neurology, University Hospital, Kerpener Str. 62, D-50937 Cologne, Germany elke.kalbe{at}uk-koeln.de

Background: Inconsistent changes of cognitive functioning have been reported in patients with Parkinson disease (PD) with deep brain stimulation (DBS) of the subthalamic nucleus (STN). To investigate the underlying pathomechanisms, we correlated alterations of cognitive test performance and changes of neuronal energy metabolism in frontal basal ganglia projection areas under bilateral STN stimulation.

Methods: We conducted verbal fluency, learning, and memory tests and 18-fluorodeoxyglucose (FDG) PET in nine patients with PD with STN-DBS before and 6 months after surgery. Using coregistered MRI, postoperative changes of the normalized cerebral metabolic rates of glucose (nCMRGlc) in the dorsolateral prefrontal cortex (DLPFC), lateral orbitofrontal cortex (LOFC), ventral and dorsal cingulum (v/dACC), and in Broca area were determined and correlated with alterations of neuropsychological test results.

Results: After surgery, highly variable changes of both cognitive test performance and frontal nCMRGlc values were found with significant correlations between verbal fluency and FDG uptake in the left DLPFC (Brodmann area [BA] 9, 46), left Broca area (BA 44/45), and the right dACC (BA 32). A decrease of nCMRGlc in the left OFC (BA 11/47) and dACC (BA 32) correlated with a decline of verbal learning. All patients showed reduced metabolic activity in the right anterior cingulate cortex after DBS. Baseline cognitive abilities did not predict verbal learning or fluency changes after surgery.

Conclusions: These data show a significant linear relationship between changes in frontal 18-fluorodeoxyglucose PET activity and changes in cognitive outcome after deep brain stimulation of the subthalamic nucleus (STN) in advanced Parkinson disease. The best correlations were found in the left frontal lobe (dorsolateral prefrontal cortex and Broca area). Baseline performance on cognitive tests did not predict cognitive or metabolic changes after STN electrode implantation.

Abbreviations: BA = Brodmann area; BDI = Beck Depression Inventory; BG = basal ganglia; CI = confidence interval; DBS = deep brain stimulation; DLPFC = dorsolateral prefrontal cortex; FDG = 18-fluorodeoxyglucose; LEDD = levodopa equivalent daily dose; LOFC = lateral orbitofrontal cortex; MDRS = Mattis Dementia Rating Scale; nCMRGlc = normalized cerebral metabolic rates of glucose; PD = Parkinson disease; RCI = Reliable Change Index; rCMRGlc = regional cerebral metabolic rate of glucose; STN = subthalamic nucleus; TE = echo time; TR = repetition time; v/dACC = ventral and dorsal cingulum; VOI = volume of interest.

Supplemental data at www.neurology.org

Funded in part by the EC-FP6-project DiMI, LSHB-CT-2005-512146.

Disclosure: The authors report no disclosures.

Received May 31, 2008. Accepted in final form September 18, 2008.




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