Deep Brain Stimulation in Elderly Patients with Parkinson’s Disease: A Systematic Review and Meta-analysis
João Vitor Fernandes1, Maria Antonia Machado Pereira2, Ocílio Gonçalves3, Victor Arthur Ohannesian4, Anderson Matheus Silva5, João Victor Gonzalez6, Murilo Mancilha7, Ygor Roberto Soares8, Kelson Almeida3
1Federal University of Paraíba, 2State University of Piauí, 3Federal University of Piauí, 4Hospital Israelita Albert Einsten, 5Federal University of Pernambuco, 6Bahiana School of Medicina, 7Anhembi Morumbi University, 8Faculty of Medical Sciences of Paraíba
Objective:
To assess the effectiveness and safety of deep brain stimulation (DBS) in elderly patients with Parkinson’s disease (PD), focusing on motor function, quality of life, cognition, mortality, complications, and age-related differences.
Background:
With the aging population, more patients with PD are reaching advanced ages when motor complications become harder to manage. DBS is effective in PD, but its outcomes in older patients remain less well defined, highlighting the need for clearer evidence to guide treatment decisions.
Design/Methods:
Cohort and comparative studies were included. Random-effects meta-analyses
assessed quality of life (PDQ-39), motor function (UPDRS-III), cognition (MMSE),
mortality, and complication rates. Subgroup analyses were performed by age
thresholds (≥65, ≥70, ≥75 years).
Results:
Sixteen studies encompassing 734 patients were analyzed. DBS significantly improved
quality of life (MD = -8.75; 95% CI: -15.17 to -2.33), though the effect was not
significant in patients ≥75 years. Motor function improved substantially (MD = –13.92;
95% CI: –19.49 to –8.35), and benefit persisted in patients ≥75 years (MD = –9.24;
95% CI: –15.09 to –3.39), whereas results for those ≥70 years were not statistically
significant. Cognition remained stable, with no significant differences in MMSE overall
(MD = 0.12; 95% CI: –0.37 to 0.61) or in subgroup analyses. Mortality was estimated at
5% (95% CI: 2–11%), with high heterogeneity, particularly in patients ≥70 years, but no
evidence of excess risk directly attributable to DBS. Complication rates did not differ
significantly between elderly and younger patients (RR = 1.43; 95% CI: 0.32–6.32).
Sensitivity analyses confirmed the robustness of findings.
Conclusions:
DBS provides meaningful motor and quality-of-life benefits for elderly PD patients while
preserving global cognition and without a clear increase in complication risk. Benefits
may be attenuated in those ≥75 years, and mortality outcomes are influenced by age
and comorbidity. Careful patient selection remains essential when considering DBS in
older populations.
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