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Dynamic Reconfiguration of Cognitive Networks and Recovery From Microlesion Effects in Parkinson's Disease: Insights
Xiang Wei1, Yuting Tian1, Qiutian Lu1
1Department of Functional Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing City, Jiangsu Province, China.
Background:
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) significantly improves motor symptoms in advanced Parkinson's disease (PD). However, the perioperative "microlesion effect" (MLE) is often associated with cognitive dysfunction, notably declines in verbal fluency (VFT). The dynamic neural mechanisms underlying cognitive network impairment during the MLE phase and functional reorganization following DBS stimulation remain poorly understood.
Aims And Methods:
This study employed longitudinal task-based functional near-infrared spectroscopy (fNIRS) to prospectively track 20 PD patients undergoing bilateral STN-DBS. To effectively disentangle the effects of natural surgical recovery from those specific to electrical stimulation, data were collected at four critical time points: 1 day preoperatively (Pre, T0), 7 days postoperatively (MLE phase, Post, T1), 1 month postoperatively with stimulation off (endpoint of natural recovery, Off, T2), and 1 week after stimulation onset (T3). VFT behavioral performance and global cognitive function (MoCA) were assessed concurrently. Hemodynamic signals from fNIRS were analyzed to examine activation changes in the prefrontal-temporal cortices. Furthermore, graph theory analysis was applied to quantify the dynamic evolution of topological properties within the core cognitive and motor networks.
Results:
VFT scores dropped during MLE (8.70 ± 2.30 to 5.70 ± 1.78, p < 0.01), partially recovering post-stimulation (8.15 ± 2.48, p < 0.05). MoCA scores also declined in MLE (25.40 ± 1.27 to 21.95 ± 1.10, p < 0.001). Neuroimaging showed activated channels decreased from 8 preoperatively to 2 during MLE (FDR-corrected), followed by reactivation to 12 channels after stimulation, particularly in dorsolateral/ventrolateral prefrontal regions. Between-group comparisons revealed enhanced activation in right DLPFC (Ch6), right SMA (Ch19), and left VLPFC (Ch47) after stimulation versus MLE (all p < 0.05, FDR-corrected).
Conclusion:
Our findings indicate that MLE-related cognitive decline may stem from acute local network disruption, while DBS can promote functional reorganization of cognitive networks. fNIRS proves to be a valuable tool for monitoring DBS-induced neuroplasticity in PD.
Insights
Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease temporarily impairs verbal fluency due to the microlesion effect (MLE). However, functional near-infrared spectroscopy (fNIRS) shows DBS promotes cognitive network recovery and neuroplasticity.
Area of Science:
- Neuroscience
- Neurosurgery
- Cognitive Science
Background:
- Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats advanced Parkinson's disease (PD) motor symptoms.
- The perioperative microlesion effect (MLE) associated with STN-DBS can lead to cognitive deficits, particularly in verbal fluency (VFT).
- The neural mechanisms of cognitive network impairment and recovery following STN-DBS are not fully understood.
Purpose of the Study:
- To longitudinally investigate cognitive network dynamics during the microlesion effect (MLE) and after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) patients.
- To differentiate between natural surgical recovery and stimulation-induced effects on cognitive function.
- To assess the utility of functional near-infrared spectroscopy (fNIRS) in monitoring neuroplasticity after STN-DBS.
Main Methods:
- A prospective study of 20 PD patients undergoing bilateral STN-DBS, using task-based functional near-infrared spectroscopy (fNIRS).
- Data collected at four time points: preoperatively (T0), 7 days postoperatively (MLE phase, T1), 1 month post-stimulation off (T2), and 1 week post-stimulation on (T3).
- Concurrent assessment of verbal fluency (VFT) and Montreal Cognitive Assessment (MoCA); analysis of hemodynamic signals and graph theory metrics for cognitive and motor networks.
Main Results:
- Verbal fluency (VFT) scores significantly declined during the MLE phase (T1) and showed partial recovery post-stimulation (T3).
- Montreal Cognitive Assessment (MoCA) scores also decreased during the MLE phase.
- fNIRS revealed reduced cortical activation during MLE, followed by significant reactivation post-stimulation, particularly in prefrontal regions (DLPFC, VLPFC, SMA).
Conclusions:
- Cognitive decline associated with the microlesion effect (MLE) may result from acute local network disruption.
- Subthalamic nucleus deep brain stimulation (STN-DBS) can facilitate functional reorganization and recovery of cognitive networks.
- Functional near-infrared spectroscopy (fNIRS) is a valuable tool for monitoring STN-DBS-induced neuroplasticity in Parkinson's disease (PD).
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