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Deep brain stimulation (DBS) has the potential to significantly reduce
motor symptoms in advanced Parkinson's disease (PD). Controversy
remains about non-motor effects of DBS and the relative advantages of
treatment at two brain targets, the globus pallidus internus (GPi) and the
subthalamic nucleus (STN). We investigated effects of DBS on
neuropsychological functioning in 42 patients with advanced PD randomly
assigned to receive staged bilateral DBS surgery of either the GPi or STN.
Patients underwent neuropsychological assessment prior to and 6 months
after unilateral surgery. Twenty-nine subsequently underwent surgery to
the contralateral side and completed a second follow-up neuropsychological
evaluation 15 months later. Unilateral treatment resulted in small but
statistically significant reductions in performance on several measures,
including verbal fluency and working memory. A similar pattern was
observed after bilateral treatment. Reductions in verbal associative
fluency were significant only after left-sided treatment. There were few
significant differences related to treatment at the two surgical targets.
Supplementary analyses suggested that decrements in select
neuropsychological domains following DBS are unrelated to age or
post-surgical reduction in dopaminergic medication dose. Findings are
discussed with reference to possible causes of neuropsychological decline
and the need for further controlled studies of specific neuropsychological
effects of DBS. (JINS, 2007, 13, 68–79.)
Higher rates of alcohol use have been reported in HIV+ individuals
compared to the general population. Both heavy alcohol use and HIV
infection are associated with increased risk of neuropsychological (NP)
impairment. We examined effects of heavy active alcohol use and HIV on
NP functioning in a large sample of community-residing HIV+ individuals
and HIV− controls. The four main study groups included 72
HIV− light/non-drinkers, 70 HIV− heavy drinkers
(>100 drinks per month), 70 HIV+ light/non-drinkers, and 56 HIV+
heavy drinkers. The heavy drinking group was further subdivided to
assess effects of the heaviest levels of active alcohol use (>6
drinks per day) on NP functioning. A comprehensive NP battery was
administered. Multivariate analysis of covariance was employed to
examine the effect of HIV and alcohol on NP functioning after adjusting
for group differences in age and estimated premorbid verbal
intellectual functioning. The analyses identified main effects of heavy
drinking and HIV on NP function, with greatest effects involving the
contrast of HIV+ heavy drinkers and the HIV− light drinkers.
Synergistic effects of heaviest current drinking and HIV infection were
identified in analyses of motor and visuomotor speed. Supplementary
analyses also revealed better NP function in the HIV+ group with
antiretroviral treatment (ART) and lower level of viral burden, a
finding that was consistent across levels of alcohol consumption.
Finally, heavy alcohol use and executive functioning difficulties were
associated with lower levels of self-reported medication adherence in
the HIV+ group. The findings suggest that active heavy alcohol use and
HIV infection have additive adverse effects on NP function, that they
may show synergistic effects in circumstances of very heavy active
alcohol use, and that heavy drinking and executive functioning may
mediate health-related behaviors in HIV disease. (JINS, 2005,
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