We will perform a pilot study to evaluate the effectiveness of human NBM DBS at improving cognitive deficits in PD patients referred and eligible for conventional DBS treatment for coexisting motor impairments. Six patients with PD with both motor fluctuations and cognitive impairments (including but not restricted to deficits in attention and working memory) will have bilateral electrodes implanted to ensure that superficial contacts lie in the conventional motor GPi target, while the deepest electrical contacts lie in the NBM- (see figure 1). We will place electrodes using our conventional image guided, stereotactic frame-based procedure currently used in patients at NHNN. Patients will be randomised into 2 groups in a crossover trial design to have 3 month periods of NBM stimulation switched on or switched off separated by a 1 month washout period, following which the patient will cross over to have the opposite condition for a further 3 months- see timeline. At the end of the crossover period, all patients will be invited for continued follow up with stimulation switched on and will have neuropsychological evaluations at 6 monthly intervals. Patients will be given the option of receiving additional conventional stimulation to the motor GPi, through the higher contacts of each electrode, at the end of the crossover period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
6
Deep Brain Stimulation targeting the Nucleus Basalis of Meynert
National Hospital for Neurology & Neurosurgery
London, United Kingdom
Abbreviated cognitive battery
Differences between each item of the abbreviated cognitive battery scores between patients after 3 months ON stimulation and 3 months OFF stimulation. CVLT-II,Verbal Fluency,Simple \& Choice RT (CANTAB),Digit span,Posner's covert attention test
Time frame: 6 months
Minimental State Examination
Time frame: 6 months
DRS-2
Dementia Rating Scale-2
Time frame: 6 months
SRM (Faces)
Short Recognition Memory for faces
Time frame: 6 months
WAIS-III (Letter number sequencing, Arithmetic)
Wechsler Abbreviated Scale of Intelligence
Time frame: 6 months
FAST
Florida Apraxia Screening test
Time frame: 6 months
NPI
Neuropsychiatric Inventory
Time frame: 6 months
BDS
Blessed Dementia Scale
Time frame: 6 months
HAM-D
Hamilton Depression scale
Time frame: 6 months
MDS UPDRS
Movement Disorders Society - Unified Parkinson's disease Rating scale
Time frame: 6 months
PDQ39
Parkinson's disease quality of life questionnaire
Time frame: 6 months
GFQ
Gait and falls questioannaire
Time frame: 6 months
NMS Quest
Non Motor Symptoms Questionnaire
Time frame: 6 months
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