Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4938-4945
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4938
Forniceal deep brain stimulation in severe Alzheimer’s disease: A case report
Wei Lin, Wei-Qi Bao, Jing-Jie Ge, Li-Kun Yang, Zhi-Pei Ling, Xin Xu, Jie-Hui Jiang, Chuan-Tao Zuo, Yu-Hai Wang
Wei Lin, Li-Kun Yang, Yu-Hai Wang, Department of Neurosurgery, Joint Logistics Support Unit No. 904 Hospital, Wuxi 214044, Jiangsu Province, China
Wei-Qi Bao, Jing-Jie Ge, Chuan-Tao Zuo, PET Center, Huashan Hospital, Fudan University, Shanghai 200235, China
Zhi-Pei Ling, Xin Xu, Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing 100039, China
Jie-Hui Jiang, School of Communication and Information Technology, Institute of Biomedical Engineering, Shanghai University, Shanghai 200444, China
Author contributions: Lin W drafted the manuscript, conducted the deep brain stimulation (DBS) surgery, analyzed the neuropsychological data, and designed the study; Bao WQ, Ge JJ, and Jiang JH drafted the manuscript, acquired and analyzed the PET data, and designed the study; Yang LK, Ling ZP, and Xu X revised the manuscript, conducted DBS surgery, analyzed neuropsychological data, and designed the study; Zuo CT critically revised the manuscript for important intellectual content, analyzed and edited PET data, and conceived the study; Wang YH critically revised the manuscript for important intellectual content, conducted the DBS surgery, analyzed and edited neuropsychological data, and conceived the study.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: All the authors of this article declare that there is no conflict of interest regarding the publication of this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yu-Hai Wang, MD, MNAMS, Doctor, Department of Neurosurgery, Joint Logistics Support Unit No. 904 Hospital, No. 101 Xingyuan Road North, Wuxi 214044, Jiangsu Province, China. wangyuhai67@126.com
Received: May 11, 2020
Peer-review started: May 11, 2020
First decision: June 7, 2020
Revised: June 11, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 26, 2020
Processing time: 163 Days and 0.7 Hours
Abstract
BACKGROUND

Forniceal deep brain stimulation (DBS) has been proposed as an alternative treatment for Alzheimer’s disease (AD). Previous studies on mild to moderate AD patients demonstrated improvements in cognitive functions brought about by forniceal DBS. Here, we report our longitudinal findings in one severe AD patient for whom the activities of daily living (ADL) rather than cognitive function significantly improved after 3 mo of continuous stimulation.

CASE SUMMARY

In 2011, a 62-year-old Chinese male with no previous history of brain injury or other neuropsychological diseases and no family history of dementia developed early symptoms of memory decline and cognitive impairment. Five years later, the symptoms had increased to the extent that they affected his daily living. He lost the ability to work as a businessman and to take care of himself. The patient was given a clinical diagnosis of probable AD and was prescribed donepezil and subsequently memantine, but no improvement in symptoms was observed. The patient then received DBS surgery. After 3 mo of continuous stimulation, the patient’s ADL score decreased from 65 points to 47 points, indicating the quality of the patient’s daily living improved distinctly. Other scores remained unchanged, suggesting no significant improvement in cognitive function. A follow-up positron emission tomography scan demonstrated perceivable increased glucose metabolism in the classical AD-related brain regions.

CONCLUSION

Based on this case we hypothesize that forniceal DBS may improve ADL through elevating regional glucose metabolism in the brain.

Keywords: Deep brain stimulation; Alzheimer’s disease; Fluorodeoxy glucose; Positron emission tomography; Activities of daily living; Case report

Core Tip: A longitudinal case study for one severe Alzheimer’s disease patient showed that forniceal deep brain stimulation may improve the activities of daily living rather than cognitive functions after 3 mo of continuous stimulation through elevating regional glucose metabolism in the brain.