A surgical procedure aimed at improving lymphatic drainage in the neck has shown potential in alleviating symptoms of advanced dementia, according to a recent trial conducted in China. Researchers at Xi’an Fengcheng Hospital Shaanxi performed the operation, known as lymphatic venous anastomosis (LVA), on 83 patients with advanced dementia, reporting notable improvements in cognitive function and brain blood flow over a nine-month period.

The procedure involves making a small incision below the jaw to access the deep cervical vein and adjacent lymphatic vessels. Surgeons create an anastomosis, or connection, between the lymphatic vessel and the vein, allowing waste proteins that contribute to dementia—such as amyloid plaques—to drain more effectively from the brain’s lymphatic system. The operation typically lasts about two hours under general anaesthesia.

This method is inspired by the established use of LVA to treat lymphoedema, a condition caused by fluid buildup following lymph node removal during cancer treatment. Now, researchers are exploring whether enhancing lymphatic drainage in the brain could reduce the accumulation of toxic proteins believed to disrupt neural communication and contribute to cognitive decline.

In the study published last month in the Journal of Alzheimer’s Disease, about 40% of patients demonstrated measurable improvement on the Mini-Mental State Exam (MMSE), a standardized test assessing memory, attention, and language skills. The remaining patients showed stabilization in their condition. Researchers noted increased alertness, responsiveness, and engagement among all participants, along with improved executive functions such as memory and planning. Reported side effects were generally mild, limited to temporary discomfort at the surgical site.

Despite these findings, the procedure remains controversial. Chinese authorities banned the surgery last year except when performed within research protocols, citing concerns over insufficient evidence regarding its safety and effectiveness. The operation has been administered primarily on a private basis to severely ill patients, some of whom have reportedly experienced dramatic, anecdotal recoveries.

Skepticism is also expressed among international experts. Robert Howard, professor of old age psychiatry at University College London, cautions that the improvements observed are minimal. He highlights that the average MMSE score increase—from 3.01 to 4.45 on a scale of 0 to 30—indicates patients remained severely impaired following surgery. Howard suggests that the absence of a control group and blinding raises the possibility that reported benefits may be influenced by placebo effects. He also notes that the underlying mechanisms producing harmful brain proteins are not addressed by the surgery, potentially limiting the durability of any clinical gains.

Currently, more than 20 clinical trials of LVA for dementia are ongoing in China, with additional investigations underway in the United States and Singapore, where a small number of patients have undergone the procedure. The medical community continues to monitor these developments closely as researchers seek effective treatments for dementia—a condition with significant global health impact and limited therapeutic options.