Alzheimer's disease (AD) is the most common form of dementia in the United States and has been associated with APOE genotype. Apolipoprotein (apo) E along with apoAI serve as the major apolipoproteins in the central nervous system; however, we are unaware of any study addressing lipoprotein metabolism in AD. We tested the hypothesis that lipoprotein metabolism is altered in patients with AD by isolating and characterizing ventricular fluid (VF) lipoproteins obtained during a rapid autopsy protocol from patients with AD and age-matched nondemented control patients. Our results demonstrated abnormalities in the protein and lipid constituents of VF lipoproteins from AD patients. Apolipoprotein concentration was reduced by half in AD patients relative to controls; however, there was no selective reduction in apoE or apoAI. In addition, cholesteryl ester fatty acids, but not phospholipid fatty acids, from AD patients demonstrated a significant reduction in some polyunsaturated fatty acids (18:2 and 22:6) and an enrichment in 18:0. None of these changes were directly related to APOE genotype. Our data indicate that VF lipoprotein composition is altered, at least terminally, in AD patients, and that these changes are not associated with APOE. These findings suggest that altered VF lipoprotein metabolism may be a component of AD pathogenesis.