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This study examined whether plasma exchange (PE) with albumin replacement could alter amyloid-β (Aβ) levels in cerebrospinal fluid (CSF) and plasma and improve cognitive function in patients with mild-to-moderate Alzheimer’s disease (AD). In this phase II trial, 42 AD patients were assigned to either PE treatment or a control group. Treated patients received up to 18 PE sessions over three schedules, followed by a six-month follow-up.

Key Findings:

• CSF Aβ1–42 levels were marginally higher in the PE-treated group compared to controls after the last treatment.
• Plasma Aβ1–42 levels were consistently lower in the PE-treated group, and plasma Aβ1–40 levels fluctuated in a pattern associated with PE sessions.
• PE-treated patients showed significant cognitive improvements, particularly in memory and language functions, as measured by the Boston Naming Test and Semantic Verbal Fluency.
• Neuropsychiatric symptoms were higher in the control group during the PE phase.

Conclusion: PE with albumin replacement modified Aβ levels in CSF and plasma and led to sustained improvements in memory and language functions in AD patients, even after PE was stopped. This suggests potential therapeutic benefits of PE in managing AD symptoms.