Does hyperbaric oxygen therapy help neurodegeneration?

Short Answer: Hyperbaric oxygen therapy (HBOT) increases brain oxygenation and may promote neuroplasticity. Small trials show cognitive improvements in Alzheimer's and TBI, but evidence is preliminary and sessions are expensive ($150-300 each).

Evidence Level: preliminary

Detailed Answer

HBOT delivers 100% oxygen at pressures above 1 atmosphere (typically 1.5-2.4 ATA), dramatically increasing dissolved oxygen in plasma and tissues. Proposed mechanisms for neurodegeneration: increased cerebral oxygenation in hypoperfused regions, stem cell mobilization, reduced neuroinflammation (TNF-α, IL-6 suppression), upregulated BDNF and VEGF (neuroplasticity and angiogenesis), and telomere elongation (Hachmo et al., 2020, Aging). A small RCT by Shapira et al. in Alzheimer's showed improved cerebral blood flow and cognitive scores after 60 sessions. HBOT has stronger evidence for traumatic brain injury and post-stroke recovery. Limitations: requires 40-60 sessions (5x/week for 8-12 weeks), cost is $6,000-18,000 per course, and mild/moderate ear barotrauma is common (~15%). Not suitable for patients with claustrophobia or untreated pneumothorax.

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