Unlocking potential: low frequency subthalamic nucleus stimulation enhances executive function in Parkinson's disease patients with postural instability/gait disturbance

Guofan Qin; Hutao Xie; Lin Shi; Baotian Zhao; Yifei Gan; Zixiao Yin; Yichen Xu; Xin Zhang; Yaojing Chen; Yin Jiang; Quan Zhang; Jianguo Zhang

doi:10.3389/fnins.2023.1228711

Unlocking potential: low frequency subthalamic nucleus stimulation enhances executive function in Parkinson's disease patients with postural instability/gait disturbance

Front Neurosci. 2023 Aug 30:17:1228711. doi: 10.3389/fnins.2023.1228711. eCollection 2023.

Authors

Guofan Qin¹, Hutao Xie¹, Lin Shi¹, Baotian Zhao¹, Yifei Gan¹, Zixiao Yin¹, Yichen Xu¹, Xin Zhang^{2

3}, Yaojing Chen⁴, Yin Jiang^{2

3}, Quan Zhang¹, Jianguo Zhang^{1

2

3}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² Beijing Key Laboratory of Neurostimulation, Beijing, China.
³ Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
⁴ State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.

Abstract

Postural instability/gait disturbance (PIGD) is very common in advanced Parkinson's disease, and associated with cognitive dysfunction. Research suggests that low frequency (5-12 Hz) subthalamic nucleus-deep brain stimulation (STN-DBS) could improve cognition in patients with Parkinson's disease (PD). However, the clinical effectiveness of low frequency stimulation in PIGD patients has not been explored. This study was designed in a double-blinded randomized cross-over manner, aimed to verify the effect of low frequency STN-DBS on cognition of PIGD patients. Twenty-nine PIGD patients with STN-DBS were tested for cognitive at off (no stimulation), low frequency (5 Hz), and high frequency (130 Hz) stimulation. Neuropsychological tests included the Stroop Color-Word Test (SCWT), Verbal fluency test, Symbol Digital Switch Test, Digital Span Test, and Benton Judgment of Line Orientation test. For conflict resolution of executive function, low frequency stimulation significantly decreased the completion time of SCWT-C (p = 0.001) and Stroop interference effect (p < 0.001) compared to high frequency stimulation. However, no significant differences among stimulation states were found for other cognitive tests. Here we show, low frequency STN-DBS improved conflict resolution of executive function compared to high frequency. Our results demonstrated the possibility of expanding the treatment coverage of DBS to cognitive function in PIGD, which will facilitate integration of low frequency stimulation into future DBS programming.

Keywords: Parkinson’s disease; cognition; conflict resolution; deep brain stimulation; executive function; low frequency; postural instability/gait disturbance; subthalamic nucleus.