ZHU Ye 1,2,3,4 , WANG Hanbin 1,3,4 , LIANG Cui 1,3,4 , HUANG Jiayi 1,3,4 , LI Yafang 1,3,4 , ZHANG Faqiang 1,3,4 , TAO Junliang 1,3,4 , BAI Fei 5 , LI Xiuxia 1,4,6
  • 1. Lanzhou University Center for Health Technology Assessment/Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
  • 2. Hulunbuir Center for Disease Control and Prevention, Hulunbuir 021000, P. R. China;
  • 3. Lanzhou University Center for Evidence-Based Medicine, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, P. R. China;
  • 4. Gansu Provincial Key Laboratory of Evidence-Based Medicine, Lanzhou 730000, P. R. China;
  • 5. National Center for Medical Service Administration, National Health Commission of the People’s Republic of China, Beijing 100086, P. R. China;
  • 6. Lanzhou University Center for Medical Device Regulation and Research, Lanzhou 730000, P. R. China;
BAI Fei, Email: gsyzbf@163.com; LI Xiuxia, Email: lixiuxia@lzu.edu.cn
Alzheimer's disease; Surgical treatment; Neurosurgery; Rapid health technology assessment
10.7507/1672-2531.202503076
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Objective  To systematically review the efficacy, safety, cost-effectiveness, indications, contraindications, and ethical issues for surgical treatment of Alzheimer's disease (AD). Methods  The CNKI, WanFang Data, VIP, PubMed, Web of Science, Embase and Cochrane Library databases were electronically searched to collect for relevant studies on surgical treatment of AD from inception to November 26, 2024. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed by using Stata 17 software. Results  A total of 59 studies were included. The results revealed that surgical treatment for AD had higher safety (OR=0.44, 95%CI 0.17 to 0.72, P<0.05), and patients had better ADAS-cog scores (SMD=0.54, 95%CI 0.18 to 0.90, P<0.05), with statistically significant differences. The economic burden of surgical treatment for AD increases with the severity of the disease. Deep brain stimulation may offer high economic benefits in the treatment of mild AD. The surgical indications can be summarized as: short disease duration, mild to moderate severity, and insufficient response to pharmacological interventions. Regarding contraindications, analysis of the included literature identified four core aspects: physiological and pathological contraindications, medical comorbidities and surgical risk contraindications, cognitive and psychological factor contraindications, and other contraindications. Ethical issues can be categorized into: informed consent and autonomy, ethical review and approval of research, and assessment of risks and benefits. Conclusion  Current evidence suggests that surgical treatment for AD has certain benefits, but the surgical approaches for treating AD are still in the exploratory stage. Limited by the number and quality of studies included, the above conclusion still requires more high-quality research to be verified.

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