Intact lexicon running slowly--prolonged response latencies in patients with subthalamic DBS and verbal fluency deficits

Abstract

Background: Verbal Fluency is reduced in patients with Parkinson's disease, particularly if treated with deep brain stimulation. This deficit could arise from general factors, such as reduced working speed or from dysfunctions in specific lexical domains.

Objective: To test whether DBS-associated Verbal Fluency deficits are accompanied by changed dynamics of word processing.

Methods: 21 Parkinson's disease patients with and 26 without deep brain stimulation of the subthalamic nucleus as well as 19 healthy controls participated in the study. They engaged in Verbal Fluency and (primed) Lexical Decision Tasks, testing phonemic and semantic word production and processing time. Most patients performed the experiments twice, ON and OFF stimulation or, respectively, dopaminergic drugs.

Results: Patients generally produced abnormally few words in the Verbal Fluency Task. This deficit was more severe in patients with deep brain stimulation who additionally showed prolonged response latencies in the Lexical Decision Task. Slowing was independent of semantic and phonemic word priming. No significant changes of performance accuracy were obtained. The results were independent from the treatment ON or OFF conditions.

Conclusion: Low word production in patients with deep brain stimulation was accompanied by prolonged latencies for lexical decisions. No indication was found that the latter slowing was due to specific lexical dysfunctions, so that it probably reflects a general reduction of cognitive working speed, also evident on the level of Verbal Fluency. The described abnormalities seem to reflect subtle sequelae of the surgical procedure for deep brain stimulation rather than of the proper neurostimulation.

Figure 1. Verbal Fluency Task.

The total number of words uttered by controls and both patient groups (each ON therapy) subdivided into the four task conditions; respective group average values are given on top of each column. Both patient groups produced significantly less words than controls. DBS patients uttered significantly less words than non-DBs patients. Values indicate the mean (± standard deviation), asterisks indicate statistically significant differnces (*: p<.05/**: p<.01). sem.: semantic; phon.: phonemic; alt.: alternating.

Figure 2. Lexical Decision Task.

Reaction time in LDT indicated for the three stimulus conditions for controls and both patient groups (each ON therapy). DBS patients showed significantly longer RTs than controls and non-DBs patients. Shortest RTs were consistently obtained for phonemically related words. Values indicate the mean RT, bars the standard error, an asterisk a statistically significant differnces (p<.05).