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Introduction: Patients in the early stages of Parkinson disease (PD) may have subtle cognitive deficits, while overt cognitive deficits are usually manifestations of late-stage PD. There is still a debate on the outcome of deep brain stimulation (DBS) on the cognitive function of PD patients. This study aimed to investigate the effect of subthalamic nucleus (STN)-DBS on the dementia of PD patients after surgery compared to medical therapy and other procedures. Methods: We searched PubMed, Scopus, Cochrane Library, and Web of Science database on October 2020, with keywords: "Deep brain stimulation," "Parkinson disease," "dementia," and "memory." Reviews, abstracts, case presentations, and letters were excluded. Results: In total, 491 studies were screened after removing the duplicates. The screening results yielded 81 articles to be screened for eligibility. Finally, 6 studies were included in this meta-analysis for synthesis. Overall, 800 patients were included in this meta-analysis, using the Mattis dementia rating scale (MDRS) and descriptive data from the articles extracted to assess global dementia. Conclusion: Our results suggest that the STN-DBS group showed a larger cognitive decline than the patients receiving the best medical treatment (BMT). However, comparing STN-DBS with globus pallidus interna stimulation and pallidotomy could not demonstrate a significant statistical effect on the global dementia of patients. More long-term studies with larger sample sizes are needed to validate current findings.
RESUMO
Background: Most in-person classes are being held via virtual platforms, and bedside education has faced serious challenges during the coronavirus disease-2019 (COVID-19) pandemic. This study evaluated the Iranian medical students' point of view regarding the virtual classes and length of education during the COVID-19 pandemic. Methods: We designed a cross-sectional study using convenience sampling about 6 months after the beginning of the COVID-19 pandemic. We formulated 4 questions regarding their satisfaction with infrastructures and contents of virtual classes, length of education, and their perspectives on how clinical and practical education should continue during the COVID-19 pandemic. We designed an online questionnaire and sent it to medical students all over the nation using virtual platforms and groups in social media. The attained data have been coded and analyzed with SPSS version 22 using descriptive and analytic tests. Results: A total of 1999 medical students participated in the study, and most students were from type 1 universities (50.4%) and were in the clerkship stage (33.3%) of education. Medical interns (mean = 3.34 [SD = 1.29]) were most satisfied with the infrastructures of virtual classes compared with students in basic sciences (mean = 2.93 [SD = 1.18]), physiopathology (mean = 2.62 [SD = 1.26]), and clerkship (mean = 2.56 [SD = 1.31]) stages (P < 0.001). Also, students in type 1 and the nongovernmental (NG) type universities were significantly more satisfied with the content, with mean scores of 2.94 and 3.14, respectively, and infrastructures, with mean scores of 2.77 and 2.98, respectively, of virtual classes than students in type 2, with mean scores of 2.59 and 2.42, respectively, and 3 universities, with mean scores of 2.54 and 2.34, respectively (P < 0.05). Conclusion: Infrastructure is a crucial component in virtual learning, and it can also affect satisfaction with the provided virtual content. Also, providing better clinical content should be performed for medical students before their internship during the current pandemic situation.