{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:34:06Z","timestamp":1775003646524,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T00:00:00Z","timestamp":1607644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:p><jats:bold>Objective<\/jats:bold>: Deep brain stimulation (DBS) targeted to the ventral intermediate (VIM) nucleus of the thalamus is effective for motor symptoms in essential tremor (ET), but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients (pre-DBS and 1+ year after DBS).<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: We identified 50 ET DBS patients; 29 (58%) males; the mean age of tremor onset was 35.84 (\u00b121.50) years with a median age of 38 years. The mean age at DBS was 68.18 (\u00b110.07) years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment (pre vs. post) and age of tremor onset (&amp;lt;38 vs. &amp;gt;38 years); <jats:italic>F<\/jats:italic><jats:sub>(1,30)<\/jats:sub> = 4.47; <jats:italic>p<\/jats:italic> = 0.043 for working memory. The <jats:italic>post hoc<\/jats:italic> testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment (pre vs. post) and complications vs. no complications subgroups; <jats:italic>F<\/jats:italic><jats:sub>(1,45)<\/jats:sub> = 4.34; <jats:italic>p<\/jats:italic> = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant.<\/jats:p><jats:p><jats:bold>Conclusion<\/jats:bold>: In this large cohort of ET patients with (&amp;gt;30% improvements), DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS.<\/jats:p>","DOI":"10.3389\/fnhum.2020.578348","type":"journal-article","created":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T07:19:23Z","timestamp":1607671163000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations"],"prefix":"10.3389","volume":"14","author":[{"given":"Jacob D.","family":"Jones","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana","family":"Orozco","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Bowers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zakia","family":"Jabarkheel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adolfo","family":"Ramirez-Zamora","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Foote","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael S.","family":"Okun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aparna","family":"Wagle Shukla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,11]]},"reference":[{"key":"B1","volume-title":"Manual for the BDI-II.","author":"Beck","year":"1996"},{"key":"B2","doi-asserted-by":"publisher","first-page":"02-74-541-1","DOI":"10.7916\/D89W0D7W","article-title":"Cognitive features of essential tremor: a review of the clinical aspects and possible mechanistic underpinnings","volume":"2","author":"Bermejo-Pareja","year":"2012","journal-title":"Tremor Other Hyperkinet. Mov."},{"key":"B4","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.neulet.2017.03.026","article-title":"The effect of deep brain stimulation of the subthalamic nucleus on executive functions: impaired verbal fluency and intact updating, planning and conflict resolution in Parkinson\u2019s disease","volume":"647","author":"Demeter","year":"2017","journal-title":"Neurosci. Lett."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1706","DOI":"10.1212\/wnl.58.11.1706","article-title":"Cognitive deficits in patients with essential tremor","volume":"58","author":"Duane","year":"2002","journal-title":"Neurology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.neuropsychologia.2016.05.028","article-title":"Effects of thalamic deep brain stimulation on spontaneous language production","volume":"89","author":"Ehlen","year":"2016","journal-title":"Neuropsychologia"},{"key":"B7","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.bandc.2016.10.001","article-title":"Thalamic deep brain stimulation decelerates automatic lexical activation","volume":"111","author":"Ehlen","year":"2017","journal-title":"Brain Cogn."},{"key":"B8","first-page":"271","article-title":"Clinical rating scale for tremor","volume":"2","author":"Fahn","year":"1993","journal-title":"Parkinsons Dis. Mov. Disord."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e58665","DOI":"10.1371\/journal.pone.0058665","article-title":"Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms","volume":"8","author":"Fakhar","year":"2013","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1136\/jnnp.74.3.305","article-title":"Neuropsychological and quality of life outcomes 12 months after unilateral thalamic stimulation for essential tremor","volume":"74","author":"Fields","year":"2003","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1159\/000342497","article-title":"Effects of deep brain stimulation in the caudal zona incerta on verbal fluency","volume":"91","author":"Fytagoridis","year":"2013","journal-title":"Stereot. Funct. Neurosurg."},{"key":"B22","volume-title":"Revised Comprehensive Norms for An Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African American and Caucasian Adults, Professional Manual.","author":"Heaton","year":"2004"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1007\/s00702-013-1030-0","article-title":"Cognitive effects of deep brain stimulation for essential tremor: evaluation at 1 and 6 years","volume":"120","author":"Heber","year":"2013","journal-title":"J. Neural Transm."},{"key":"B13","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1080\/13803390701754738","article-title":"Cognitive deficits in essential tremor consistent with frontosubcortical dysfunction","volume":"30","author":"Higginson","year":"2008","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.jad.2017.07.014","article-title":"Neurocognition in patients with psychotic and non-psychotic bipolar I disorder. A comparative study with individuals with schizophrenia","volume":"222","author":"Jim\u00e9nez-L\u00f3pez","year":"2017","journal-title":"J. Affect. Disord."},{"key":"B15","doi-asserted-by":"publisher","first-page":"81","DOI":"10.3988\/jcn.2009.5.2.81","article-title":"Cognitive impairment in essential tremor without dementia","volume":"5","author":"Kim","year":"2009","journal-title":"J. Clin. Neurol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s00702-017-1741-8","article-title":"Bilateral thalamic deep brain stimulation for essential tremor in elderly patients","volume":"124","author":"Klein","year":"2017","journal-title":"J. Neural Transm."},{"key":"B17","doi-asserted-by":"publisher","first-page":"3085140","DOI":"10.1155\/2017\/3085140","article-title":"Cognitive impact of deep brain stimulation on Parkinson\u2019s disease patients","volume":"2017","author":"Mehanna","year":"2017","journal-title":"Parkinsons Dis."},{"key":"B18","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1002\/ana.21596","article-title":"Cognition and mood in Parkinson\u2019s disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial","volume":"65","author":"Okun","year":"2009","journal-title":"Ann. Neurol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.brs.2014.02.012","article-title":"Verbal fluency in essential tremor patients: the effects of deep brain stimulation","volume":"7","author":"Pedrosa","year":"2014","journal-title":"Brain Stimul."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3171\/2019.9.JNS191646","article-title":"Deep brain stimulation in the caudal zona incerta in patients with essential tremor: effects on cognition 1 year after surgery","author":"Philipson","year":"2019","journal-title":"J. Neurosurg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"S197","DOI":"10.1002\/mds.20956","article-title":"Deep brain stimulation for Parkinson\u2019s disease: surgical issues","volume":"21","author":"Rezai","year":"2006","journal-title":"Mov. Disord."},{"key":"B23","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.biopsych.2005.09.019","article-title":"Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed","volume":"60","author":"Sheline","year":"2006","journal-title":"Biol. Psychiatry"},{"key":"B3","volume-title":"State-Trait Anxiety Inventory.","author":"Spielberge","year":"2010"},{"key":"B24","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1037\/0735-7044.99.4.621","article-title":"Mammillothalamic tracts and representational memory","volume":"99","author":"Thomas","year":"1985","journal-title":"Behav. Neurosci."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1097\/HS9.0000000000000497","article-title":"Neuropsychological and quality of life outcome after thalamic stimulation for essential tremor","volume":"53","author":"Tr\u00f6ster","year":"1999","journal-title":"Neurology"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e98","DOI":"10.1212\/WNL.0000000000001456","article-title":"Changes in cognitive abilities after deep brain stimulation for Parkinson disease","volume":"84","author":"Tr\u00f6ster","year":"2015","journal-title":"Neurology"},{"key":"B27","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1046\/j.1468-1331.2002.00341.x","article-title":"Neuropsychological deficits in essential tremor: an expression of cerebello-thalamo-cortical pathophysiology?","volume":"9","author":"Tr\u00f6ster","year":"2002","journal-title":"Eur. J. Neurol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1016\/s0010-9452(08)70877-3","article-title":"Contributions of thalamic nuclei to declarative memory functioning","volume":"39","author":"Van der Werf","year":"2003","journal-title":"Cortex"},{"key":"B29","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1136\/jnnp.2005.081232","article-title":"Deep-brain stimulation: long-term analysis of complications caused by hardware and surgery\u2013experiences from a single centre","volume":"77","author":"Voges","year":"2006","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B30","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.clinph.2019.10.019","article-title":"Effects of ventral intermediate nucleus deep brain stimulation across multiple effectors in essential tremor","volume":"131","author":"Wilkes","year":"2020","journal-title":"Clin. Neurophysiol."},{"key":"B160","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/S1353-8020(03)00014-2","article-title":"Pulse width is associated with cognitive decline after thalamic stimulation for essential tremor","volume":"9","author":"Woods","year":"2003","journal-title":"Parkinsonism Relat. Disord."}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2020.578348\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T07:19:25Z","timestamp":1607671165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2020.578348\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,11]]},"references-count":31,"alternative-id":["10.3389\/fnhum.2020.578348"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2020.578348","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,11]]},"article-number":"578348"}}