While piracetam increases nerve cell membrane fluidity and normalizes hyperactive platelet aggregation, its effects are considerably potentiated by CDP-choline, idebenone, vinpocetine, and selegiline. Piracetam enhances the antihypoxic effect of CPH by protecting cell membranes from phospholipid peroxidation. Oxiracetam, aniracetam, and pramiracetam have shown greater benefits than piracetam. Human studies using racetams to augment the effects of CDP-choline and other cholinesterase inhibitors are needed. Large double-blind, placebo-controlled studies support racetam benefits in poststroke aphasia and dyslexia. (For reviews, see Table 39–8 and Brown et al. 2009.) Piracetam given within 7 hours of stroke, combined with speech therapy, enhanced language recovery (De Deyn et al. 1997). In postconcussion syndrome, piracetam reduced symptoms (especially vertigo and headache) and accelerated recovery (Hakkarainen and Hakamies 1978). PET scans demonstrated improved task-related blood flow in the left hemisphere speech area in poststroke patients given piracetam (Kessler et al. 2000). In practice, ginkgo and piracetam can synergistically augment language retraining for dyslexia and aphasia: gingko improves attention and perception; piracetam improves learning. In a DBRPC of 98 patients with ischemic stroke following coronary artery bypass surgery, those treated with piracetam had significant improvement in cognitive function versus placebo (Szalma et al. 2006).