Objective: To assess the benefit of deep brain stimulation (DBS) to improve cognition in Parkinson’s Disease (PD).

Background: Patients with advanced PD suffer from both motor and cognitive impairment, with no effective options for treating both simultaneously. DBS of the nucleus basalis of Meynert (NBM) is an emerging target believed to improve cognitive function.

Method: We performed a phase-II double-blind cross-over pilot trial to demonstrate the feasibility and safety of simultaneously targeting the Globus Pallidus Pars Interna (GPi) and NBM in six patients with PD and cognitive impairment. Secondary and exploratory outcomes include motor and cognitive outcomes as well as neurophysiological and neuroimaging biomarkers of NBM stimulation.

Results: NBM DBS did not improve cognition, and four patients converted to dementia by the end of the trial. However, DBS stimulation improved the motor scores of the Movement Disorder Society Unified PD Rating Scale up to 1-year post -surgery (p=0.028) as well as the dyskinesia and motor fluctuation scores (p=0.04). NBM stimulation was associated with a positive correlation between glucose metabolism in the right supramarginal gyrus and semantic fluency scores (p<0.01). Patients who remained cognitively stable by the end of the study had increased functional connectivity in the left parietal region with NBM stimulation (p=0.023).

Conclusion: Simultaneous stimulation of the GPi and NBM is safe in advanced PD patients and improves PD-associated motor symptoms and complications. Although NBM stimulation did not result in significant cognitive improvement, neuroimaging suggests that it impacts functional connectivity in the adjacent cortex.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/single-trajectory-multiple-target-deep-brain-stimulation-to-treat-mobility-and-cognition-in-parkinsons-disease-a-double-blind-randomized-cross-over-pilot-study/