title: Omentum transposition surgery for patients with Alzheimer's disease: a case series.
abstract: OBJECTIVE
  To examine effect of omentum transposition surgery (OT) in Alzheimer's disease (AD).
  
  
  METHODS
  Within-subjects design, also known as repeated-measures design, was used. OT was performed on six biopsy-confirmed AD patients (three to the left and right hemispheres each). Follow-up was conducted over 16-50 months. Outcome measures included the sum of the sub-scores of the clinical dementia rating scale (CDRSS), dementia severity rating scale (DSRS), mini-mental status exam (MMSE) and neuropsychiatric inventory (NPI), all normalized to 0-1.0. Outcomes were compared to baseline values and to expected decline with and without cholinesterase inhibitors therapy (ChEI).
  
  
  RESULTS
  Compared to baseline and to expected decline with ChEI, CDRSS scores were 22 and 39% less impaired at means of 14 and 25 months post-OT, and DSRS scores were 12 and 22% less impaired at means of 14 and 19 months post-OT (p<0.0001). Compared to baseline and expected course with and without ChEI, the MMSE scores of the left hemisphere OT patients were not significantly different for 11, 17 and 22 months respectively (p>0.49), while those of the right hemisphere OT patients more rapidly declined. The two patients with significant pre-operative behavioral problems markedly improved; NPI severity scores decreased by 23 (16%) and 78 (54%) points and were sustained for 22 and 42 months.
  
  
  CONCLUSIONS
  OT yielded cognitive, functional or behavioral improvement for up to 3.5 years in these AD patients. Compared to randomized ChEI clinical trials, OT was 34 times more likely to produce clinically significant improvement. Basic research to identify the mechanisms underlying the therapeutic effect of omentum is warranted.
authors.affiliation: Fountain Valley Regional Hospital and Medical Center, Fountain Valley, CA 92708, USA. rshankle@shankleclinic.com
authors.forename: William R
authors.initials: WR
authors.lastname: Shankle
authors.forename: Junko
authors.initials: J
authors.lastname: Hara
authors.forename: Lynda
authors.initials: L
authors.lastname: Bjornsen
authors.forename: George F
authors.initials: GF
authors.lastname: Gade
authors.forename: Peter C
authors.initials: PC
authors.lastname: Leport
authors.forename: Mir B
authors.initials: MB
authors.lastname: Ali
authors.forename: Jinho
authors.initials: J
authors.lastname: Kim
authors.forename: Maryellen
authors.initials: M
authors.lastname: Raimo
authors.forename: Linda
authors.initials: L
authors.lastname: Reyes
authors.forename: Daniel
authors.initials: D
authors.lastname: Amen
authors.forename: Lisa
authors.initials: L
authors.lastname: Rudy
authors.forename: Terence
authors.initials: T
authors.lastname: O'Heany
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003071:Cognition / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009852:Omentum / Q000601:surgery*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D016378:Tissue Transplantation / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors