Age-related cerebellar decline and integrated cerebellar tDCS-exercise therapy intervention: A narrative review from a neuroplastic perspective for fall prevention

Objective: To review cerebellar aging mechanisms related to falls and to summarize evidence for combining cerebellar transcranial direct current stimulation (ctDCS) with task-oriented exercise therapy. Design: Narrative review. Methods: PubMed, EMBASE, PEDro, and Google Scholar were searched for peer-reviewed human studies published until November2025 using Medical Subject Headings and text words on aging, cerebellum, tDCS,balance, gait, motor learning, and falls. Studies were included if they applied ctDCS and reported balance- or gait-related outcomes in patients ≥65 years or aging-related neurodegenerative populations. Animal/cellular studies, conference abstracts, editorials, case reports, and non-cerebellar stimulation-only studies were excluded. Reference lists of included studies were also screened (snowballing). Results: Aging-related cerebellar decline can impair sensory integration, internal model updating, and error-based learning; thereby, increasing postural sway, gait variability, and dual-task gait decrements, which are key targets for rehabilitation to prevent falls. ctDCS may prime training-dependent plasticity by modulating cerebellar excit ability and cerebello-cortical interactions. Across the available studies, ctDCS combined with balance/postural or gait practice generally suggests improvements in postural stability, locomotor adaptation, and selected dual-task walking outcomes, with mostly mild transient adverse effects. Conclusions: ctDCS–exercise integration is a clinically relevant adjunct concept for physiotherapy to prevent falls, but current evidence is limited by the heterogeneity of protocols and outcomes. Future pragmatic randomized trials are required to optimize individualized protocols, standardize clinically meaningful measures, evaluate retention, and determine whether functional improvements translate into a reduced incidence of falls in the community and in outpatient settings.