Shunting in AD slows progression of the dementia

Background The pathogenesis of Alzheimer's disease (AD) may involve impaired clearance of toxic metabolites, e.g. amyloid-beta peptides (Aβ), from the brain via interstitial fluid (ISF) and cerebrospinal fluid (CSF) circulation, and the blood-brain barrier (BBB). If so, then increasing ISF and CSF circulation may improve CSF Aβ clearance and may slow the progression of AD. We tested this hypothesis in a prospective, randomized, double-blind, placebo-controlled trial of low-flow CSF shunting. Our previously reported analysis using the Generalised Estimating Equations showed no effect of CSF shunting. The present report provides post hoc analyses using linear mixedeffects models fit by maximum likelihood.