Parkinson Hastalığında Bilişsel Ağların Dinamik Yeniden Yapılanması ve Mikrolezyon Etkilerinden İyileşme: Uzun Boylu FNIRS Çalışmasından Öngörüler.

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BackgroundBilateral 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 methodsThis 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.ResultsVFT scores dropped during MLE (8.70 ± 2.30 to 5.70 ± 1.78, p ConclusionOur 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.

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