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. 2025 Aug 29;30(1):820.
doi: 10.1186/s40001-025-03064-7.

Cognitive effects of adaptive deep brain stimulation in Parkinson's disease: stability without risk

Roberta Ferrucci  1   2 , Fabiana Ruggiero  3 , Edoardo Nicolò Aiello  4 , Sara Marceglia  5 , Marco Prenassi  6 , Barbara Poletti  4 , Francesca Cortese  7 , Tommaso Bocci  8   5 , Denise Mellace  9 , Mattia Arlotti  10 , Natale Maiorana  8   5 , Francesca Mameli  3 , Linda Borellini  3 , Filippo Cogiamanian  3 , Enrico Mailland  3 , Nicola Ticozzi  4 , Maurizio Vergari  3 , Elena Pirola  3 , Antonella Ampollini  3 , Luigi Remore  3   11 , Marco Locatelli  3   11 , Sergio Barbieri  3 , Alberto Priori  8   5
Affiliations

Cognitive effects of adaptive deep brain stimulation in Parkinson's disease: stability without risk

Roberta Ferrucci et al. Eur J Med Res. .

Abstract

Background: Adaptive deep brain stimulation (aDBS) is a closed-loop system that adjusts stimulation based on patient biomarkers. This study evaluated the cognitive safety of aDBS in Parkinson's disease (PD).

Methods: Sixteen PD patients with bilateral subthalamic DBS underwent cognitive assessments (attention, language, memory) 6 days post-surgery during an 8 h protocol. Testing occurred at five time points: T1 (aDBS, medication "off"), T2/T4 (aDBS, medication "on"), and T3/T5 (aDBS "on", medication "off"). Four patients followed the same protocol with continuousDBS (cDBS).

Results: Results showed no cognitive fluctuations in aDBS patients (p ≥ 0.110). However, cDBS patients exhibited significant reaction time (RT) variations (p = 0.019), with RTs lower at T1 than T3 (p = 0.011) and T5 (p = 0.021), and at T4 compared to T2 (p = 0.002).

Conclusion: These findings suggest that 8 h aDBS may not adversely affect cognitive performance, providing preliminary evidence of its cognitive safety and stability in PD.

Keywords: Adaptive DBS; Continuous DBS; Language; Memory; Reaction times.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Informed consent was obtained from all subjects involved in the study. Competing interests: RF: AP, SB, ML, SM, FC, MA are founders and stakeholders of Newronika S.p.A.

Figures

Fig. 1.
Fig. 1.
The timeline depicts the 8 h aDBS experimental protocol. Patients were free to engage in daily activities within the hospital between assessments. Cognitive and clinical evaluations were performed at five time points under different stimulation and medication conditions: T1: DBS ‘off’/medication ‘off’ (baseline, after overnight washout); T2 and T4: DBS on/medication ‘on’ (≈60 min post-levodopa intake); T3 and T5: DBS ‘on’/medication ‘off’ (≈60–90 min post-peak dose). Each session included clinical motor evaluation, reaction times task, verbal fluency, naming, and word recognition tasks. aDBS remained active throughout the day, except at T1. DBS: deep brain stimulation; aDBS: adaptive DBS; StimON/OFF: stimulation on/off; MedON/OFF: medication on/off; RTs: reaction times
Fig. 2.
Fig. 2.
Trends in cognitive score across the five time points, on the left adaptive DBS (aDBS), on the right conventional DBS (cDBS). A Reaction times (RTs); (B) phonemic verbal fluency (PVF) scores; (C) semantic verbal fluency (SVF) scores; (D) Naming scores; (E) Recognition scores. T1: aDBS “off”–medication “off”; T2: aDBS “on”–medication “on”; T3: aDBS “on”–medication “off”; T4: aDBS “on”–medication “on”; T5: aDBS “on”–medication “off”. Data are expressed as mean ± standard error of the mean (SEM). Higher scores on the y-axis indicate better performances for all cognitive measures except for RTs, where lower scores indicate better performances
See this image and copyright information in PMC

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