Table 39–8. Evidence for nootropics
Hakkarainen and Hakamies 1978Hakkarainen and Hakamies 1978
DBRPC 8-week study of 60 patients with postconcussion
syndrome of 2–12 months; 4,800 mg/day piracetam
reduced symptoms (especially vertigo and headache) and accelerated
electroencephalogram normalization and hospital discharge.
Deberdt 1994Deberdt 1994
In dyslexia, AAMI, and aphasia, significant augmentation
of cognitive retraining: gingko improved attention and perception;
piracetam improved learning.
Enderby et al. 1994Enderby et al. 1994
DBRPCMC study of 158 poststroke patients, 137 studied
after 12-week treatment and 88 at 24-week follow-up; 31 patients
on piracetam (45%) and 37 on placebo (53%) were aphasic
on entry. Groups matched at baseline for demographic data, stroke
sequelae, type and severity of aphasia, and prognostic parameters.
Multivariate analysis of Aachen Aphasia subtest showed significant
overall improvement relative to baseline in favor of piracetam (P = 0.02)
at 12 weeks.
Piracetam did not show advantage at 24 weeks, but 43% of
subjects were not retested.
Israel et al. 1994Israel et al. 1994
DBRC trial of 162 AAMI patients, age >55
years, 3-month memory training program (MTP), MTP + piracetam.
Best results: MTP after 45 days of piracetam 4.8 mg/day. Piracetam
2.4 mg/day immediate
recall; piracetam 4.8 mg/day immediate, delayed,
and global recall.
Boiko et al. 2007Boiko et al. 2007
Open series study of 50 patients with focal brain lesions
and chronic fatigue syndrome: 29 patients with multiple sclerosis;
21 patients with posttraumatic encephalopathy, transient ischemic
attacks (vascular encephalopathy), and other postencephalitic syndromes.
Fezam (400 mg piracetam and cinnarizine 25 mg) improved fatigue, anxiety,
and depression in two-thirds of the 21 patients without multiple
De Deyn et al. 1997De Deyn et al. 1997
DBRPC study of 452 patients given piracetam within
7 hours of ischemic stroke, 12 g daily for 4 weeks and 4.8 g/day
for 8 weeks. Neurological outcome Orgogozo scale scores at 4 weeks
(piracetam 60.4, placebo 54.9; P = 0.07)
and functional status Barthel Index scores at 12 weeks (piracetam
58.6, placebo 49.4; P = 0.02).
Kessler et al. 2000Kessler et al. 2000
DBRPC study of 24 poststroke aphasia patients, 6 weeks
intensive speech therapy; 12 given piracetam 2,400 mg/day improved
6 language functions; 12 given placebo improved
3 language functions. Piracetam significant task-related
flow activation in left hemisphere speech areas vs. placebo.
Szalma et al. 2006Szalma et al. 2006
6-week DBRPC study of 98 patients with ischemic stroke
following coronary artery bypass surgery. Patients given piracetam
(150 mg/kg/day iv the day before and 6 days after
surgery; 300 mg/kg iv day of surgery; and 12 g/day
po up to 6 weeks) significant improvement
in cognitive function (P = 0.041)
vs. no treatment effect with placebo.
Szaflarski et al. 2007Szaflarski et al. 2007
Retrospective review of 379 charts of TBI patients
treated with antiepileptic drugs in neuroscience ICU. Diagnoses:
trauma (29.1%), subarachnoid hemorrhage (26.3%), brain
tumor (20.4%), subdural hemorrhage (18.4%). Leviracetam
(Keppra) monotherapy shorter
ICU stays and fewer complications than phenytoin monotherapy or
Sano et al. 1997Sano et al. 1997
DBRPC trial of 340 patients with moderately severe
Alzheimer's disease given selegiline 10 mg/day,
alpha-tocopherol (vitamin E 2,000 IU/day), a combination
of both, or placebo for 2 years. Selegiline, alpha-tocopherol, and
the combination slowed progression as indicated by time to institutionalization,
death, loss of ability to perform activities of daily living, or
severe dementia vs. placebo.
Newburn and Newburn 2005Newburn and Newburn 2005
Four cases post-TBI apathy without depression. Each
patient responded to selegiline (less than 20 mg/day) with
significant improvements in Apathy Evaluation Scale scores: declines
of 23, 46, 20, and 41 points. Patients had many other problems (e.g.,
memory, attention, information processing, balance, communication,
and impulse control); they also showed improvements in ability to
function at work and at home.