Cognitive Outcome After Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: A Systematic Review

Tim A M Bouwens van der Vlis; Annelien Duits; Mégan M G H van de Veerdonk; Anne E P Mulders; Koen R J Schruers; Yasin Temel; Linda Ackermans; Albert F G Leentjens

doi:10.1111/ner.13534

Cognitive Outcome After Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: A Systematic Review

Neuromodulation. 2022 Feb;25(2):185-194. doi: 10.1111/ner.13534.

Authors

Tim A M Bouwens van der Vlis¹, Annelien Duits², Mégan M G H van de Veerdonk³, Anne E P Mulders⁴, Koen R J Schruers⁵, Yasin Temel⁶, Linda Ackermans⁶, Albert F G Leentjens²

Affiliations

¹ Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address: tim.bouwens@mumc.nl.
² Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands; School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
³ Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁴ Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁵ Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands; School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Mondriaan Mental Health Center, Maastricht, The Netherlands.
⁶ Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands; School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.

PMID: 35125137
DOI: 10.1111/ner.13534

Abstract

Introduction: Deep brain stimulation (DBS) is an effective treatment for refractory obsessive-compulsive disorder (OCD). Neuropsychological assessment contributes to DBS treatment in several ways: it monitors the cognitive safety of the treatment, identifies beneficial or detrimental cognitive side effects, and it could aid to explain variability in treatment outcome, and possibly the treatment's working mechanism(s).

Background: This systematic review assessed the cognitive safety of DBS for OCD and explored whether changes in cognitive function may help explain its working mechanism(s).

Materials and methods: EMBASE, PubMed/Medline, Psycinfo, and the Cochrane Library were systematically searched for studies reporting cognitive outcomes following DBS for OCD. Searches were completed in November 2020. Included studies were appraised for study design and quality according to National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools.

Results: Five randomized controlled trials and ten observational studies comprising a total of 178 patients were analyzed collectively. Variable outcomes of DBS were observed in the domains of attention, memory, executive functioning, and in particular, cognitive flexibility.

Conclusion: Although individual studies generally do not report cognitive deterioration after DBS for OCD, the variability of study designs and the multitude of cognitive measures used precluded a meta-analysis to confirm its safety and recognition of a cognitive pattern through which the efficacy of DBS for OCD might be explained. In the future, prospective studies should preferably include a standardized neuropsychological assessment battery specifically addressing executive functioning and have a longer-term follow-up in order to demonstrate the cognitive safety of the procedure. Such prospective and more uniform data collection may also contribute to our understanding of the working mechanisms of DBS in OCD.

Keywords: Cognitive outcome; deep brain stimulation; obsessive–compulsive disorder.

Publication types

Review
Systematic Review

MeSH terms

Cognition
Deep Brain Stimulation*
Humans
Obsessive-Compulsive Disorder* / therapy
Prospective Studies
Randomized Controlled Trials as Topic
Treatment Outcome