Rethinking age barriers in Parkinson's disease for deep brain stimulation

Area of Science:

• Neurology
• Neurosurgery
• Geriatrics

Background:

• The established age cutoff for subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) is typically under 70 years.
• This study investigates the efficacy of STN-DBS in patients aged 70 years and older compared to younger patients.

Purpose of the Study:

• To compare the efficacy of STN-DBS in Parkinson's disease patients aged ≥70 years versus <70 years.
• To evaluate the impact of age on motor function and medication requirements post-STN-DBS.
• To inform a more inclusive approach to STN-DBS treatment for elderly PD patients.

Main Methods:

• Retrospective, cross-sectional cohort study of 360 Parkinson's disease patients undergoing STN-DBS (2002-2019).
• Comparison of outcomes between 15 patients aged ≥70 years and 61 patients aged <70 years.
• Primary outcome: Movement Disorder Society - Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III) reduction.
• Secondary outcome: Reduction in levodopa equivalent daily dose (LEDD).
• Statistical analysis using SPSS-25 with p < 0.05 significance threshold.

Main Results:

• No significant differences in MDS-UPDRS-III scores were observed between the age groups at baseline, 1 year, or 3 years post-STN-DBS.
• Postoperative reduction in levodopa equivalent daily dose (LEDD) was similar in both groups.
• Patients aged 70 years and older required a higher LEDD at three years follow-up compared to younger patients.

Conclusions:

• STN-DBS demonstrates comparable motor improvements (MDS-UPDRS-III) in Parkinson's disease patients regardless of age (≥70 vs <70).
• Elderly patients (≥70 years) required higher medication dosages (LEDD) at three years post-STN-DBS.
• Further research is needed to assess the cost-effectiveness and optimize STN-DBS for older Parkinson's disease populations.