SingHealth PGY1 Program, Singapore General Hospital, Singapore.
Department of Neurology, National Neuroscience Institute, Singapore.
Clin Neurol Neurosurg. 2024 Jul;242:108319. doi: 10.1016/j.clineuro.2024.108319. Epub 2024 May 7.
The decision to offer deep brain stimulation (DBS) to elderly patients with Parkinson's disease (PD) presents challenges due to higher perceived risks and uncertain long-term benefits. Here, we aimed to compare the outcomes after DBS for elderly versus non-elderly patients with PD.
We analyzed data from our institutional cohort and retrieved publicly available data through a systematic review. The exposure was age at DBS electrode insertion, which was defined as elderly (≥70 years old) and non-elderly (<70 years old). The outcomes examined were changes in the Movement Disorders Society-Parkinson's Disease Rating Scale (MDS-UPDRS) or UPDRS part III total score, levodopa-equivalent daily dose (LEDD), and adverse events.
The included studies and our cohort comprised a total of 527 patients, with 111 (21.1 %) classified as elderly. There was no statistically significant difference in the change in MDS-UPDRS or UPDRS part III total score and generally no statistically significant difference in the change in LEDD between the elderly and non-elderly patients. Elderly patients had a higher incidence of wound infection (elderly 5.4 % vs non-elderly 1.9 %; p = 0.087) and inadequate wound healing (elderly 3.6 % vs non-elderly 1.4 %; p = 0.230), but this difference was not statistically significant. There was no significant difference in the incidence of mortality (elderly 0 % vs non-elderly 0 %; p = 1.000), stroke (elderly 0 % vs non-elderly 0.2 %; p = 1.000), and cognitive decline between the age groups.
Notwithstanding the trend towards a higher risk of wound infection and inadequate wound healing, elderly patients have similar motor outcomes and levels of PD medication reduction as non-elderly patients after DBS for PD. Hence, age should not be used as the sole criterion for determining eligibility for DBS, and the decision to offer DBS to elderly patients should be personalized and made in a multidisciplinary setting, taking into consideration patient- and disease-related factors.
由于感知到的风险较高和不确定的长期获益，对于患有帕金森病（PD）的老年患者，提供脑深部电刺激（DBS）的决策存在挑战。在这里，我们旨在比较老年和非老年 PD 患者接受 DBS 后的结果。
我们分析了我们机构队列的数据，并通过系统评价检索了公开可用的数据。暴露因素为 DBS 电极插入时的年龄，定义为老年（≥70 岁）和非老年（<70 岁）。检查的结果是运动障碍协会帕金森病评定量表（MDS-UPDRS）或 UPDRS 第三部分总分、左旋多巴等效日剂量（LEDD）和不良事件的变化。
纳入的研究和我们的队列共包括 527 名患者，其中 111 名（21.1%）被归类为老年。老年和非老年患者的 MDS-UPDRS 或 UPDRS 第三部分总分的变化以及一般而言 LEDD 的变化均无统计学显著差异。老年患者的伤口感染发生率较高（老年 5.4% vs 非老年 1.9%；p = 0.087）和伤口愈合不良发生率较高（老年 3.6% vs 非老年 1.4%；p = 0.230），但差异无统计学意义。两组之间的死亡率（老年 0% vs 非老年 0%；p = 1.000）、中风（老年 0% vs 非老年 0.2%；p = 1.000）和认知能力下降发生率无显著差异。
尽管存在伤口感染和伤口愈合不良风险较高的趋势，但与非老年患者相比，接受 DBS 治疗 PD 的老年患者在运动结果和 PD 药物减少水平方面相似。因此，年龄不应作为确定 DBS 资格的唯一标准，并且应在多学科环境中个性化地做出向老年患者提供 DBS 的决定，同时考虑到患者和疾病相关因素。
