The videos are amazing. In one scene, an elderly Chinese woman seems lost in the wilderness of dementia, unable to answer basic questions; in the next, she appears to be chatting lucidly and shelling beans for dinner. Clearly, years of cognitive decline had been quickly reversed after the patient underwent a new experimental surgical procedure.
The only problem is that no one knows if it’s real.
It’s difficult to take any video at face value in the age of AI, and this experimental procedure occurred in China, a country with a recent history of controversial science touting extraordinary but questionable claims. In recent years, researchers have published several papers reporting promising results from a procedure believed to attack Alzheimer’s disease in a special way: by connecting vessels from lymph nodes in the neck to nearby veins in an effort to drain the brain of harmful waste. But these were small studies that did not include a control group. The doctor who first performed the operation was reportedly placed under arrest, and the Chinese government sought to prevent most doctors from performing such operations.
Is it because it’s a scam? Or because it’s dangerous? Or could it be because there have not yet been proper randomized trials, compared to placebo, to assess the safety and effectiveness of the procedure? New studies are planned in China to more rigorously evaluate this surgery.
But scientists around the world have many questions. And now a small group of researchers in the United States and Europe are working to find the answers. In the next few years, we should know whether this surgery could really be the miracle the viral videos make it out to be — or another high-profile treatment that ultimately fails.
Dr. Adnan Siddiqui, a neurosurgeon at the University at Buffalo who is leading a first U.S. study of the procedure, has already helped develop a new treatment for severe stroke patients. It gave doctors a valuable new technique for treating patients in emergencies, and he told me he sees it rapidly changing the standard of care around the world. In an interview, he warned that much more work needs to be done to evaluate this proposed new treatment for Alzheimer’s disease – but at the same time, he is optimistic.
“The paradigm of the whole world has changed in the blink of an eye. It can happen. And I hope it could be that second home run,” he said. In 2027, we will start to receive clear signals one way or the other. By 2028, 2029 we will know if this is real or not.
Why This Alzheimer’s Surgery Could Really Work
The promise of this controversial new procedure lies in the lymphatic system, which is essentially the body’s drainage system. According to scientists’ best current theories about Alzheimer’s disease, the brain’s filtration system deteriorates with age and, as a result, plaques made of amyloid proteins as well as tau protein tangles can build up in people’s brains and eventually lead to neurological damage, leading to severe memory loss linked to Alzheimer’s disease. Researchers have found that these amyloid and tau proteins also accumulate, not only in the brain, but also in the lymph nodes of older people.
So could minimally invasive surgery to improve brain drainage have such a dramatic impact on Alzheimer’s disease?
Siddiqui, who also directs the Jacobs Institute at the University at Buffalo, which focuses on new technologies for vascular and neurological diseases, had been interested in the role of the lymphatic system in Alzheimer’s disease even before he heard about this experimental work done in China by a colleague years ago. The colleague had gone to see Dr. Qingping Xie, the surgeon who began performing lymphatic surgery on Alzheimer’s patients about six years ago. To further his research, Siddiqui traveled to South Korea to meet with a plastic surgeon, Dr. Joon Pio Hong, who was performing a new, “more refined” version of the same basic procedure, as Siddiqui put it. But as in China, these were not strictly speaking randomized experiments. There was no placebo.
So Siddiqui wanted to see if he could test it himself. After carrying out proof-of-concept operations in 2025 with a new microrobotic tool (for a rare disease involving constriction of blood vessels in the brain), he and his colleagues decided to take an even bigger step: testing this new technology to perform lymphatic surgery for Alzheimer’s disease.
The researchers filed an application with the U.S. Food and Drug Administration and received approval late last year for five initial procedures; Over the summer, they received the green light to perform the procedure on 15 patients. Several operations have already been carried out and Siddiqui told me he has four more planned for next week.
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The mechanism makes only superficial sense: If Alzheimer’s disease is the byproduct of amyloid and tau that build up in the brain because the body can no longer filter them, bypassing a clogged “drain” in the lymphatic system could help remove the proteins and relieve symptoms. It is, in a different way, the same therapeutic target as recent breakthrough drugs that slow the cognitive decline of an Alzheimer’s patient.
But instead of an injection, the procedure involves a small incision in the neck, allowing surgeons to connect the lymph nodes to a vein. The hope is that creating this new drainage pathway will help the brain clear out amyloid and tau more effectively and “hopefully bypass any blockages that might be in the system,” Siddiqui said.
This first round of surgeries in the United States is part of what is called an initial feasibility study. “You’re just trying to prove that it’s definitely safe, feasible and maybe effective,” Siddiqui said. They measure not only patients’ cognitive performance, but also other data points, such as changes in their gait, to detect any signs of benefit or harm.
If the results are promising, a second feasibility study will involve a larger number of patients, around fifty. After that, if the evidence suggests they should move forward, scientists would start introducing placebos. In the case of surgery, this means that some patients would undergo “sham” surgeries that would do nothing. Then, investigators would compare the experiences of the two groups: the people who had the fake surgery and those who had the real surgery.
If the latter group improves significantly more than the former, that would allow scientists to say with certainty: yes, this surgery actually works to treat Alzheimer’s disease.
“Obviously, this is exactly the kind of disease that there is so much hype and so much hope for,” Siddiqui told me. It is therefore essential to carry out careful research to justify it.
But let’s not get ahead of science
Siddiqui has been in this position before – and he’s seen it go both ways. There was the new treatment for stroke which was proven to be effective and has since become the standard worldwide. But he was also one of the first researchers to study a treatment for multiple sclerosis, somewhat similar to surgery for Alzheimer’s disease. After initial promise, the project failed when randomized trials began.
“I wouldn’t be a neurosurgeon if I wasn’t an eternal optimist,” he said. “However, I am a clinical trialist and I still respect the placebo.”
Placebos are essential, but they are also tricky. If someone thinks they received active treatment as part of a study, they tend to think they will benefit from it. This also applies to surgical treatments. It is therefore essential to follow patients and their symptoms after the intervention to see to what extent the effects can be attributed to the treatment and to what extent they could be a placebo effect. The latter could also be reinforced by loved ones who desperately want to see their parent or spouse get better.
Alzheimer’s disease is also a complex disease that we do not yet fully understand. Although scientists believe there is a relationship between amyloid and tau proteins and Alzheimer’s disease, other factors, such as inflammation and vascular health, may also play a role. Some previous drug candidates were successful in clearing amyloid plaque, but patients did not improve. Some people have a buildup of amyloid in their brain but never develop Alzheimer’s disease.
Dr. Bohdan Pomahac, division chief of plastic and reconstructive surgery at the Yale School of Medicine, is overseeing studies intended to further establish the basis for how these proteins pass through the lymphatic system. This research includes determining whether blockage actually occurs in patients with Alzheimer’s disease and, if so, where these blockages are usually located. Only after doing this work, he said, will his team be comfortable offering surgical interventions to relieve the blockage and see if that helps improve Alzheimer’s patients’ symptoms.
He told me about seeing Xie, the pioneering Chinese surgeon for the procedures, speak at a plastic surgery conference a few years ago. (Plastic surgeons are experts in the type of microsurgery required for the procedure, and several are involved in ongoing Alzheimer’s disease trials.)
“I think most people, including myself at the time, dismissed it as, ‘He’s some kind of charlatan,'” Pomahac said. “But he came back every year to the conferences and started showing more and more videos. We weren’t sure. Are they actors? We couldn’t…
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