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Deep cervical lymphovenous anastomosis (LVA) for Alzheimer's disease: microsurgical procedure in a prospective cohort study
Chen JY, Zhao DW, Yin Y, Gui L, Chen X, Wang XM, Wang PB, Zuo CH et al.. International journal of surgery (London, England), 2025-05-20
Topic: Amyloid, tau and blood-test diagnosis
Plain-language summary
Objectives Alzheimer's disease (AD) is a prevalent neurodegenerative disorder, characterized by progressive cognitive decline. Current approved drugs merely relieve symptoms rather than halt or reverse disease progression. The role of the brain lymphatic system in clearing harmful substances in the brain has provided new insights for AD treatment. The goal of this study was to assess the efficacy and safety of deep cervical lymphovenous anastomosis (LVA) in treating AD patients. Materials and methods A single-center, prospective, single-arm exploratory study was conducted on 26 AD patients who met the clinical and biomarker diagnostic criteria of the National Institute on Aging-Alzheimer's Association (NIA-AA). Deep cervical LVA was performed with modified technique from lymphatic vessel-vein to lymphatic flap-vein anastomosis. Preoperative and follow-up neuropsychological tests were carried out using Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Neuropsychiatric Inventory (NPI) scores. Cerebrospinal fluid (CSF) biomarkers (Aβ42, Aβ40, p-Tau, T-Tau) were collected and analyzed via single-molecule immunoassay in the early postoperative period. Results One month after surgery, about 60% of caregivers reported varying degrees of overall symptom improvement in patients. MMSE scores of patients significantly increased after surgery compared with before surgery (3 [0, 6] vs. 5 [0, 7], P = 0.022). Although, 15% of patients had increased MoCA scores, 42% had decreased NPI scores, both changes did not reach statistical difference. Quantitative analysis revealed a trend toward reduced AD biomarker levels following LVA, but the differences did not reach statistical significant. Only two patients experienced postoperative difficulty raising their arms, with gradual recovery during follow-up. Conclusion This study demonstrates that deep cervical LVA is safe and feasible procedure, showing a significant cognitive improvement in AD patients (mainly in MMSE), which needs long-term follow-up and large-scale clinical trials to verify.
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APA 7th
Chen, J. Y., Zhao, D. W., Yin, Y., Gui, L., Chen, X., Wang, X. M., et al. (2025). Deep cervical lymphovenous anastomosis (LVA) for Alzheimer's disease: microsurgical procedure in a prospective cohort study. International journal of surgery (London, England). https://doi.org/10.1097/js9.0000000000002490
Vancouver
Chen JY, Zhao DW, Yin Y, Gui L, Chen X, Wang XM, et al. Deep cervical lymphovenous anastomosis (LVA) for Alzheimer's disease: microsurgical procedure in a prospective cohort study. International journal of surgery (London, England). 2025. doi:10.1097/js9.0000000000002490. PMID: 40391969.
BibTeX
@article{chen2025-40391969,
author = {Chen, J. Y. and Zhao, D. W. and Yin, Y. and Gui, L. and Chen, X. and Wang, X. M. and Wang, P. B. and Zuo, C. H. and others},
title = {{Deep cervical lymphovenous anastomosis (LVA) for Alzheimer's disease: microsurgical procedure in a prospective cohort study}},
journal = {International journal of surgery (London, England)},
year = {2025},
doi = {10.1097/js9.0000000000002490},
pmid = {40391969},
url = {https://doi.org/10.1097/js9.0000000000002490}
}
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Key findings
- Results One month after surgery, about 60% of caregivers reported varying degrees of overall symptom improvement in patients.
- MMSE scores of patients significantly increased after surgery compared with before surgery (3 [0, 6] vs. 5 [0, 7], P = 0.022).
- Quantitative analysis revealed a trend toward reduced AD biomarker levels following LVA, but the differences did not reach statistical significant.
- Conclusion This study demonstrates that deep cervical LVA is safe and feasible procedure, showing a significant cognitive improvement in AD patients (mainly in MMSE), which needs long-term follow-up and large-scale clinical trials to verify.
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Study details
- Evidence strengthLow
How this study scored 41/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multicenter collaboration, so those were left out: it earned 24 of the 58 points we could judge it on, which is 41 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (International journal of surgery (London, England)) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multicenter collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40391969) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 24 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 24 of the 58 points we could judge it on is 41 out of 100. |
| Total | 41 / 100 | — |
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