NeuroSPECT demonstrates increased cortical function in Alzheimer's disease patients for at least two years after omental transposition neurosurgery

Clinical improvement following surgical transposition of the omentum to the brain (OTS) has been observed in a variety of neurologic disorders, including stroke, encephalitis, cerebral palsy, spinal cord transaction and Alzheimer's disease. The basis for such improvement is not known, but may relate to the presence of stem cells and growth factors in the omentum, which have been implicated in angiogenesis, neurogenesis and neuronal survival. The present report describes the changes in brain activity in two patients with biopsy confirmed Alzheimer's disease (AD) whose course had entered a phase of more rapid decline prior to OTS. The patients were followed with disease severity (Clinical Dementia Rating Scale), cognitive (Mini-Mental Status Exam) and HMPAO NeuroSPECT measures for 22 and 42 months. Dementia severity lessened for 2 or more years while cortical activity in areas underneath, adjacent to, and contralateral to the omentum increased by 1-2 standard deviations above the patient's preoperative baseline (maximum increase was 21%, 4 Standard Deviations). In the more mildly demented AD patient 22 months after OTS, the posterior cingulate cortex showed up to a 20% increase in activity compared to is preoperative level of activity. This is remarkable in that the omentum had no direct contact with the posterior cingulate gyrus, which is involved in the early stages of AD neuropathology (Braak and Braak stages 3-4). These findings warrant further investigation into the mechanism(s) by which the omentum can improve cortical activity and clinical function for two or more years in Alzheimers' disease (au)