Deep Brain Stimulation in Parkinson's Disease Patients Over 75 Years of Age: A Single-Institution Retrospective Analysis

Aim

Elderly patients (aged 75 years and older) with Parkinson's disease (PD) are commonly considered unsuitable for deep brain stimulation (DBS) because of its limited benefits for this population and high risk. Understanding therapeutic heterogeneity in terms of effectiveness and safety can help in personalized prognostic and preoperative evaluations.

Methods

The clinical data of 1680 PD patients who underwent DBS surgery in our hospital between April 2007 and July 2023 were retrospectively analyzed. Sixty-eight of the patients were aged 75 years or older at the time of treatment. The patients were stratified into two groups according to the disease duration: 38 had PD for < 10 years, and 30 had PD for ≥ 10 years. The baseline data, including sex, Hoehn–Yahr scores, PD classification, comorbidities, levodopa responsiveness, anesthesia and operation methods, were compared to confirm the comparability of the results. The Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale-part 3 (MDS-UPDRS-III) score (off- or on-medication condition, off-medication/on-stimulation condition, and on-medication/on-stimulation condition), levodopa equivalent daily dose (LEDD), 39-item Parkinson's disease questionnaire (PDQ-39) score, activities of daily living (ADL) scale score, and adverse events were obtained and compared between the two groups preoperatively and at the postoperative follow-up.

Results

Among the two groups of patients, no significant differences in sex, PD classification, comorbidities, levodopa responsiveness, anesthesia method, or operation method were observed. In both groups of patients, the postoperative MDS-UPDRS-III scores were significantly lower than the preoperative MDS-UPDRS-III scores. However, the LEDD, PDQ-39 score, and ADL score did not decrease significantly in patients with a disease duration ≥ 10 years. The incidence rate of complications was significantly higher in this group of patients.

Conclusions

DBS surgery is effective for improving motor symptoms in elderly PD patients (aged 75 years and older) in the short and long term. Patients with a longer duration of disease (≥ 10 years) cannot easily reduce the use of anti-Parkinsonian drugs, improve their quality of life, or improve their ability to perform daily living activities. These PD patients often suffer relatively more temporary complications, which should be taken seriously by doctors.