Postoperative changes in cervical hemodynamics and cognitive function following cervical lymphatic-venous surgery in Alzheimer's disease

Background Alzheimer's disease (AD) has been increasingly linked to cervical venous and lymphatic dysfunction, impairing cerebral perfusion and clearance of neurotoxic metabolites. Deep cervical lymphatic-venous anastomosis (dcLVA) is a microsurgical approach aimed at restoring lymphatic-venous communication. Objective To evaluate postoperative changes in cervical hemodynamics and cognitive function in patients with AD. Methods Eighty-three AD patients underwent bilateral cervical LVA. Pre- and postoperative evaluations included Doppler ultrasound of the internal jugular veins and carotid arteries at both hyoid and cricoid levels, along with standardized cognitive and functional tests. Morphologic and hemodynamic changes were analyzed using the Wilcoxon and Spearman analysis. Results Postoperatively, significant increases were observed in venous and arterial flow, along with enlargement of internal jugular and carotid cross-sectional areas. Postoperative improvements were observed, with postoperative carotid flow moderately correlated with Mini-Mental State Examination and activities of daily living. Longitudinal follow-up demonstrated sustained neuropsychological improvement up to 9 months, with persistent enhancement of vascular flow in a follow-up subgroup. Conclusions The procedure was associated with changes in vascular parameters and clinical outcomes; however, the specific contribution of dcLVA cannot be determined.