title: Piracetam Improves Activated Blood Flow and Facilitates Rehabilitation of Poststroke Aphasic Patients Treatment trial of oxiracetam in Alzheimer's disease. Piracetam therapy does not enhance cognitive functioning in children with down syndrome. Effect of piracetam on cognitive performance in patients undergoing bypass surgery. Cerebroprotective effect of piracetam in patients undergoing open heart surgery. Acetyl-l-Carnitine Treatment in Minimal Hepatic Encephalopathy Persistence of the effects of Cerebrolysin on cognition and qEEG slowing in vascular dementia patients: Results of a 3-month extension study A 22-week, multicenter, randomized, double-blind controlled trial of Crocus sativus in the treatment of mild-to-moderate Alzheimer’s disease Treatment of cognitive impairment secondary to degenerative dementia. Effectiveness of oxiracetam therapy. Cognitive outcome after coronary artery bypass: a one-year prospective study. [Effects of CDP-choline on dynamic changes in LCBF and cognitive function in demented subjects--an H2 15O-PET study]. Cerebroprotective effect of piracetam in patients undergoing coronary bypass burgery. Piracetam prevents cognitive decline in coronary artery bypass: a randomized trial versus placebo. Acetyl-l-carnitine reduces depression and improves quality of life in patients with minimal hepatic encephalopathy Piracetam improves children's memory after general anaesthesia.
abstract: Background and Purpose In a prospect i ve , double-blind , placebo-controlled study , it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow . Methods Twenty-four stroke patients with aphasia were r and omly allocated to 2 groups : 12 patients received  2400 mg piracetam twice daily , 12 placebo . Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy , the patients were examined neuropsychologically and studied with H215O PET at rest and during activation with a word-repetition task .  Blood flow was analyzed in 14 language -activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images . Results Before treatment , both groups were comparable with respect to performance in language tasks and to type and severity of aphasia . In the piracetam group , increase of activation effect was significantly higher ( P < 0.05 ) in the left transverse temporal gyrus , left triangular part of inferior frontal gyrus , and left posterior superior temporal gyrus after the treatment period compared with the initial measures . The placebo group showed an increase of activation effect only in the left vocalization area . In the test battery , the piracetam group improved in 6 language functions , the placebo group only in 3 subtests . Conclusions Piracetam as an adjuvant to speech therapy improves recovery of various language functions , and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere Twenty-four carefully assessed patients with probable Alzheimer 's disease were enrolled in a double-blind , placebo-controlled treatment study of oxiracetam , a nootropic agent reported to improve memory performance in patients with dementia . A broad battery of neuropsychological tests failed to reveal any improvement in the treated group or in any treated patient when individual test scores were analyzed . These findings indicate that oxiracetam is ineffective in reducing cognitive impairment due to Alzheimer 's disease BACKGROUND Piracetam is widely used as a purported means of improving cognitive function in children with Down syndrome . Its efficacy , however , has not been rigorously assessed . OBJECTIVE To determine whether 4 months of piracetam therapy ( 80 - 100 mg/kg per day ) enhances cognitive function in children with Down syndrome . DESIGN A r and omized , double-blind , placebo-controlled crossover study . PARTICIPANTS AND METHODS Twenty-five children with Down syndrome ( aged 6.5 - 13 years ) and their caregivers participated . After undergoing a baseline cognitive assessment , children were r and omly assigned to 1 of 2 treatment groups : piracetam-placebo or placebo-piracetam . MAIN OUTCOME MEASURE The difference in performance while taking piracetam vs while taking placebo on tests assessing a wide range of cognitive functions , including attention , learning , and memory . RESULTS Eighteen children completed the study , 4 withdrew , and 3 were excluded at baseline . Piracetam therapy did not significantly improve cognitive performance over placebo use but was associated with central nervous system stimulatory effects in 7 children : aggressiveness ( n = 4 ) , agitation or irritability ( n = 2 ) , sexual arousal ( n = 2 ) , poor sleep ( n = 1 ) , and decreased appetite ( n = 1 ) . CONCLUSION Piracetam therapy did not enhance cognition or behavior but was associated with adverse effects In this study , the protective effect of piracetam on select aspects of cognitive function in patients undergoing bypass surgery was investigated . Male patients ( n = 64 ) with an indication for a surgical revascularization using artificial extracorporal circuits were r and omly assigned in a double-blind fashion to receive a single challenge of 12-g piracetam infusion or placebo ( sterile saline ) prior to the bypass surgery . A brief battery of neuropsychological tests for verbal and non-verbal short-term memory and attention was administered 1 day before and 3 days after the surgical intervention . There was a significant difference in short-term memory and attention , with the piracetam-treated patients producing a better level of performance 3 days after surgery compared to the placebo group . The overall postoperative cognitive function ( z-transformation of all 6 test results ) was more significantly ( p < 0.001 ) reduced in the placebo group than in the piracetam group ( z = -1.19 + /- 0.72 vs. -0.46 + /- 0.58 , respectively ) . A single challenge of 12-g piracetam infusion prior to surgical intervention might offer a short-term neuroprotective effect for patients undergoing cardiac bypass surgery . Whether this effect persists for a longer period of time requires further investigation OBJECTIVES Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass ( CPB ) during cardiac surgery . Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery , we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery . METHODS Patients scheduled for elective open heart surgery were r and omized to the piracetam or placebo group in a double-blind study . Patients received 12 g of piracetam or placebo at the beginning of the operation . Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer 's Disease Assessment Scale were performed preoperatively and on day 3 , postoperatively . To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery , we combined the six test-scores by principal component analysis . RESULTS A total of 88 patients with a mean age of 67 years were enrolled into the study . The mean duration of CPB was 110 minutes . Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups . The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups ( piracetam : preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38 , p < 0.0005 and placebo : preoperative -0.14 ± 0.98 vs. postoperative -1.35 ± 1.23 , p < 0.0005 ) . Patients taking piracetam did not perform better than those taking placebo , and both groups had the same decline of overall cognitive function ( p = 0.955 ) . CONCLUSION Piracetam had no cerebroprotective effect in patients undergoing open heart surgery . Unlike the patients who underwent coronary surgery , piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients Minimal hepatic encephalopathy ( MHE ) is characterized by disturbance of mental state and neuromuscular function . To assess the clinical efficacy of acetyl-l-carnitine ( ALC ) in the treatment of MHE , we performed a r and omized , double-blind , placebo-controlled study administering ALC in cirrhotic patients with this disease and evaluating their cognitive functions . One hundred and twenty-five cirrhotic patients , of whom 21 were infected by hepatitis B virus , 75 by hepatitis C virus and 29 with cryptogenic cirrhosis , were enrolled in our study . Patients were r and omly divided into two groups , and using double-blind administration , group A was treated with ALC and group B with placebo for 90 days . The two groups were similar in demographic characteristics , aetiology of cirrhosis , duration and Child-Pugh grade . Minimal hepatic encephalopathy was diagnosed with the Trail Making Test ( TMT ) , Symbol Digit Modalities Test ( SDMT ) and Auditory Verbal Learning Test ( AVL ) and cognitive function with the Mini Mental State Examination ( MMSE ) . After 90 days in group A treated with ALC , we observed a significant decrease in prothrombin time ( P < 0.001 ) , bilirubin serum levels ( P < 0.01 ) , AST ( P < 0.001 ) , fasting NH4 serum levels ( P < 0.001 ) , Trail Making Test-A ( P < 0.001 ) and Trail Making Test-B ( P < 0.001 ) , and a significant increase in albumin serum levels ( P < 0.005 ) , MMSE test ( P < 0.001 ) , Symbol Digit Modalities Test ( P < 0.001 ) , BDT ( P < 0.001 ) , AVL long-term test ( P < 0.001 ) and AVL total test ( P < 0.001 ) . No significant differences were observed in EEG in either group of patients treated with ALC or placebo . The benefits of ALC in comparison with placebo are demonstrated in greater reductions in serum ammonia levels , as well as in improvements of neuropsychological functioning The maintenance of the effects of Cerebrolysin , a peptidergic compound with neurotrophic activity , on cognitive performance and qEEG activity was investigated through a 12-week , open-label extension of a 4-week , r and omised , placebo-controlled pilot study . Thirty-three out of 41 patients with mild-to-moderate severe probable vascular dementia ( VaD ) according to NINDS-AIREN participating in the double-blind phase of the study were also assessed at the follow-up visit at week 16 . Patients received i.v . infusions of Cerebrolysin ( 10 or 30 mL ) or placebo ( saline ) 5 days/week for 4 weeks . Neuropsychological evaluations and qEEG recordings were done at baseline , week 4 and week 16 . The mean change in score from baseline in the ADAS-cog+ and the slow-to-fast qEEG power ratio ( PR ) , used as an index of qEEG slowing , were the two primary endpoints . Correlations between changes in cognition and qEEG induced by the treatment were also assessed . At the week 16 follow-up visit , Cerebrolysin improved ( p<0.05 ) cognitive performance at the 10-mL and 30-mL doses and reduced qEEG slowing significantly ( p<0.05 ) at the 30-mL dose with respect to the placebo . In addition , a significant ( p<0.05 ) positive correlation between the change from the baseline qEEG PR and ADAS-cog+ variables was observed at week 16 . These results indicate a persistence of the beneficial effects of Cerebrolysin on cognition and qEEG activity in VaD patients for at least 12 weeks after treatment cessation , and they suggest the potential utility of qEEG parameters as biomarkers for VaD clinical trials Rationale There is increasing evidence to suggest the possible efficacy of Crocus sativus ( saffron ) in the management of Alzheimer ’s disease ( AD ) . Objective The purpose of the present investigation was to assess the efficacy of C. sativus in the treatment of patients with mild-to-moderate AD . Methods Fifty-four Persian-speaking adults 55 years of age or older who were living in the community were eligible to participate in a 22-week , double-blind study of parallel groups of patients with AD . The main efficacy measures were the change in the Alzheimer ’s Disease Assessment Scale — cognitive subscale and Clinical Dementia Rating Scale — Sums of Boxes scores compared with baseline . Adverse events ( AEs ) were systematic ally recorded . Participants were r and omly assigned to receive a capsule saffron 30 mg/day ( 15 mg twice per day ) or donepezil 10 mg/day ( 5 mg twice per day ) . Results Saffron at this dose was found to be effective similar to donepezil in the treatment of mild-to-moderate AD after 22 weeks . The frequency of AEs was similar between saffron extract and donepezil groups with the exception of vomiting , which occurred significantly more frequently in the donepezil group . Conclusion This phase II study provides preliminary evidence of a possible therapeutic effect of saffron extract in the treatment of patients with mild-to-moderate Alzheimer ’s disease . This trial is registered with the Iranian Clinical Trials Registry ( I RCT 138711051556N1 ) The effectiveness of Oxiracetam ( 1600 mg/day ) versus placebo was assessed in a group of 96 out- patients suffering from cognitive disorders secondary to primary degenerative dementia . The study lasted twelve months and was performed in two stage , a ) double-blind ( 26 weeks ) and b ) open study ( 26 weeks ) . The assessment of the results obtained at two , six and twelve months was carried out following both the methodology based on neuropsychological tests and scales , and the study of the simple reaction time by any of a computerized portable tachystoscope . The patients treated with Oxiracetam showed a statistically significant improvement of simple reaction time and cognitive function detected by the Attention matrix . In the placebo group after twelve months a significant worsening of cognitive and global function was observed in comparison with baseline scores . The patients themselves appeared in favor of Oxiracetam . The drug tolerability proved to be very good for the whole duration of the treatment . The authors believe that Oxiracetam favorably acts on the symptoms of senile cerebral deterioration and can improve the capability of information processing , as suggested by the better performances obtained at the reaction time test and at the Attentional Matrix test BACKGROUND Cognitive deficits have been reported in patients after coronary artery bypass grafting  , but the incidence of these deficits varies widely . We studied prospect ively the incidence of cognitive change and whether the changes persisted over time . METHODS Cognitive testing was done preoperatively and 1 month and 1 year postoperatively in 127 patients undergoing coronary artery bypass grafting .  Tests were grouped into eight cognitive domains . A change of 0.5 st and ard deviation or more at 1 month and 1 year from patient 's preoperative Z score was the outcome measure . RESULTS We identified four main outcomes for each cognitive domain : no decline ; decline and improvement ; persistent decline ; and late decline . Only 12 % of patients showed no decline across all domains tested ; 82 % to 90 % of patients had no decline in visual memory , psychomotor speed , motor speed , and executive function ; 21 % and 26 % had decline and improvement in verbal memory and language ; approximately 10 % had persistent decline in the domains of verbal memory , visual memory , attention , and visuoconstruction ; and 24 % had late decline ( between 1 month and 1 year ) in visuoconstruction . CONCLUSIONS This study establishes that the incidence of cognitive decline varies according to the cognitive domain studied and that some patients have persistent and late cognitive changes in specific domains after coronary artery bypass grafting We studied correlations of serial changes in local cerebral blood flow ( LCBF ) after single intravenous ( i.v . ) injection of cytidine diphosphate choline ( CDP-choline ) to changes in cognitive function in demented subjects after its daily administration for one week . The study group consisted of 7 patients with dementia of vascular origin ( VD group ; mean age 65.0 years ) and 3 patients with dementia of non-vascular origin ( non-VD group ; 64.7 years ) .  Cognitive function was evaluated with the Japanese version of the Cross Cultural Cognitive Examination ( CCCE ) . After i.v . injection of CDP-choline , mean supratentorial LCBF increased with the maximum value at 40 minutes post-injection in the VD-group , but decreased in the non-VD group ( Type , n.s . ; Time , n.s . ; Type x Time , p < 0.01 ; ANOVA ) . The number of the pass-tasks in CCCE increased significantly after the 7 days-injection of CDP-choline only in the VD group ( p < 0.05 ) , while it was fairly stable in 15 control patients , who were matched in age and severity of dementia to the study patients . In this group , a change in the number of pass-tasks was significantly correlated with those in LCBF at ROIs in the left and right temporal cortices and the right thalamus . In the non-VD group , there were no significant changes of mean supratentorial LCBF and of the number of pass-tasks in CCCE . These results may be attributable to difference in availability of the acetylcholine neurotransmitter system in the brain between VD- and non-VD patients BACKGROUND Reduction of cognitive function is a possible side effect after cardiac surgery using cardiopulmonary bypass . We investigated the cerebroprotective effect of piracetam on cognitive performance in patients undergoing coronary artery bypass surgery under cardiopulmonary bypass . MATERIAL / METHODS Patients scheduled for elective , primary and isolated coronary bypass surgery were r and omised either to piracetam or  placebo  group . The study was performed in a double blind fashion . Patients received either 12 g piracetam or placebo at the beginning of the operation . Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer 's Disease Assessment Scale were performed preoperatively and on the third postoperative day . To assess the overall cognitive function and the degree of cognitive decline across all tests after surgery we combined the six test-scores by principal component analysis . RESULTS A total number of 120 patients were enrolled into the study . Preoperative overall cognitive function were not significantly different between the groups . The postoperative combined score of the neuropsychological tests showed a deterioration of cognitive function in both groups ( placebo-pre : -0.06+/-0.99 vs placebo-post : -1.38+/-1.11 ; p<0.0005 and piracetam-pre : 0.06+/-1.02 vs piracetam-post : -0.65+/-0.93 ; p<0.0005 ) . However , the piracetam patients performed significantly better compared to the placebo patients after the operation and had a less decline of overall cognitive function ( p<0.0005 ) . CONCLUSIONS Piracetam has a cerebroprotective effect in patients undergoing coronary artery bypass surgery with the use of cardiopulmonary bypass . It reduces an early postoperative substantial decline of neuropsychological abilities BACKGROUND Coronary artery bypass grafting ( CABG ) can be associated with postoperative cognitive impairment and ischemic stroke . No effective treatment is currently available . The aim of this study was to evaluate the effectiveness of piracetam to treat the cognitive impairment  after CABG in an investigator-initiated , double-blind , placebo-controlled , r and omized clinical trial . METHODS Patients undergoing CABG ( n = 98 ) were r and omized to placebo  ( n = 48 ) or  piracetam  ( n = 50 ) . Study drugs were administered intravenously ( 150 mg/kg daily ; 300 mg/kg on the day of surgery ) from the day before surgery to 6 days after surgery , then orally ( 12 g/day ) up to 6 weeks after surgery . Cognitive function was assessed before surgery ( baseline ) and 6 weeks after surgery ( outcome ) by using a battery of 12 neuropsychologic tests . The Spielberger Anxiety Inventory and the Beck Depression Inventory were also administered . The combined score derived from the st and ardized neuropsychologic assessment s was analyzed by using an analysis of covariance with baseline and education as covariates . RESULTS Six weeks after surgery , the combined score indicated a statistically significant treatment effect in the per protocol population ( 1.848 , p = 0.041 ) and a tendency towards statistical significance in the intent-to-treat population ( 1.624 , p = 0.064 ) in the group treated with piracetam , but no statistically significant treatment effect was seen in the placebo . The state of anxiety measured by the Spielberger Anxiety Inventory was decreased in both groups ( -9.27 and -6.37 in the placebo and piracetam groups , respectively ) . CONCLUSIONS Six weeks after CABG , cognition was significantly improved in patients treated with piracetam .  Additional trials are required to confirm these effects Abstract Background . Minimal hepatic encephalopathy ( MHE ) represents a common complication present in well-compensated cirrhotic patients that impairs patients ' daily functioning and health-related quality of life ( HRQL ) . Acetyl-l-carnitine ( ALC ) has been shown to be useful in improving blood ammonia and cognitive functions in cirrhotic patients with MHE . Objective . This study evaluated the effects of ALC treatment on HRQL and depression in patients with MHE . Study design . This was a r and omized , double-blind , placebo-controlled study . Sixty-seven patients with MHE were recruited to the study . They were r and omly assigned to two groups and received either 2 g acetyl-l-carnitine twice a day ( n = 33 ) or placebo ( n = 34 ) for 90 days . The primary efficacy measures were changes in aspartate aminotransferase , alanine aminotransferase , γ-glutamyl-transpeptidase , albumin , alkaline phosphatase , prothrombin time , and ammonia . Clinical and laboratory assessment s , psychometric tests and automated electroencephalogram ( EEG ) analysis were performed for all patients . Results . At the end of the study period , between the two groups , we observed a significant difference in physical function ( p < 0.001 ) , role physical ( p < 0.001 ) , general health ( p < 0.001 ) , social function ( p < 0.05 ) , role emotional ( p < 0.05 ) , mental health ( p < 0.05 ) , Beck Depression Inventory ( p < 0.001 ) , TMT-B s ( p < 0.001 ) , State Trait Inventory ( p < 0.001 ) , urea ( p < 0.05 ) , NH4 + ( p < 0.001 ) , and bilirubin ( p < 0.001 ) . Conclusions . This study shows that ALC treatment is associated with significant improvement in patient energy levels , general functioning and well-being . The improvement of quality of life is associated with reduction of anxiety and depression BACKGROUND Surgery and anaesthesia may account for postoperative complications including cognitive impairment . The purpose of the study was to assess the influence of general anaesthetics on children 's memory and effectiveness of piracetam for prevention of postoperative cognitive dysfunction . METHODS The study included patients receiving different kinds of anaesthesia for various surgical procedures , r and omly allocated to two groups . According to immediate postoperative treatment , the study group received intravenous piracetam 30 mg kg(-1 ) and the control group -- placebo . The cognitive functions were examined preoperatively and within 10 consecutive postoperative days using the ten-word memory test . RESULTS The study group consisted of 123 children , the control one -- of 127 . Declines in memory indexes were observed in all anaesthetized patients . The most injured function was long-term memory . The intravenous administration of piracetam improved this cognitive function . CONCLUSIONS The study results confirm that general anaesthesia affects the memory function in children .  Piracetam is effective for prevention of postoperative cognitive dysfunction after anaesthesia
target: From the data reported in the literature , it emerges that nootropics may be an effective alternative for strengthening and enhancing cognitive performance in patients with a range of pathologies .
  Although nootropics , and specifically the cholinergic precursors , already have a long history behind them , according to recent renewal of interest , they still seem to have a significant therapeutic role .
  Drugs with regulatory indications for symptomatic treatment of Alzheimer 's disease , such as cholinesterase inhibitors and memantine , often have transient effects in dementia disorders .
background: Nootropics represent probably the first " smart drugs " used for the treatment of cognitive deficits .
  The aim of this paper is to verify , by a systematic analysis of the literature , the effectiveness of nootropics in this indication .
  The analysis was limited to nootropics with cholinergic activity , in view of the role played by acetylcholine in learning and memory .
  Acetylcholine was the first neurotransmitter identified in the history of neuroscience and is the main neurotransmitter of the peripheral , autonomic , and enteric nervous systems .