The cerebrospinal fluid production rate is reduced in dementia of the Alzheimer’s type
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To the Editor:
The recent article by Silverberg et al.1 concludes that the rate of CSF production is reduced in AD compared to PD, based on observations made using the Masserman technique. In 1931, Masserman calculated the rate of CSF formation in patients by measuring the time needed for the CSF pressure to return to its initial level following drainage of a standard volume of CSF by lumbar puncture. After drainage of 20 to 35 mL of CSF, pressure was restored at a rate of about 0.32 mL/min. Silverberg et al. modified the technique to removing 3 mL via a ventricular catheter. The Masserman technique has long been criticized because it assumed a constant rate of CSF formation and absorption. The rate of formation is relatively stable but the absorption rate varies greatly with changes in intracranial pressure.
Silverberg et al.1 failed to consider the important role of intracranial compliance in determining the pressure changes that occur following CSF drainage. Intracranial compliance, defined as dV/dP (change in volume/change in pressure), …
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