New Scientist reports on the work of neurophysiologist named Yuri Moskalenko who is proposing that people with Alzheimer’s disease may benefit from trepanation (the drilling of a small hole in the skull).

Trepanation has been practiced by various cultures for thousands of years to treat everything from schizophrenia to migraines to uncorking evil spirits trapped in the skull.
Today, removal of sections of skull is usually (but not always…. here is a little DIY trepanation) undertaken to release the build up of intercrainial pressure, following trauma or intercerebral bleeds.

Whilst the actual cause of Alzheimer’s is still being unravelled, there is evidence that decreased blood flow and a falling production of cerebrospinal fluid (CSF) may be a significant agent.
CSF carries nutrients and removes waste products including tau and beta-amyloid proteins that may lead to plaque formation commonly found in the brains of people with Alzheimer’s.
As we age and our brain becomes less elastic or compliant, closing down the flow of blood and CSF.
By drilling a hole in the skull, pressure is relieved and the compliance increases:

Moskalenko studied 15 people who had undergone the procedure following head injuries. He found that their cranial compliance was around 20 per cent higher than the average for their age. Based on this, he calculates that a 4-square-centimetre hole increases cerebral blood flow by between 8 and 10 per cent, which is equivalent to 0.8 millilitres more blood per heartbeat (Human Physiology, vol 34, p 299). This, he says, shows that trepanation could be an effective treatment for Alzheimer’s, and he even goes so far as to suggest that it might provide a “significant” improvement in the mental functions of anyone from their mid-40s, when cranial compliance starts to decline.
A 4-square-centimetre hole increases cerebral blood flow by between 8 and 10 per cent.

Other scientists are exploring the use of spinal taps (lumbar punctures) to remove CSF volume as well a any accumulated toxins with some initial positive results.

Harriet Millward, deputy chief executive of UK-based charity Alzheimer’s Research Trust, is keeping an open mind. “The procedure has been understudied so far and, until further research has been undertaken, the possibility of beneficial effects remains open,” she says. David Smith, a neuropharmacologist and head of the Oxford Project to Investigate Memory and Ageing, is even more receptive. “I think the observations look pretty robust,” he says. In the absence of drug treatments for dementia, “these rather drastic surgical ones are worth considering”, he says.

You can read the entire article in New Scientist here.