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Gregory S, Saunders S, Ritchie CW. Science disconnected: the translational gap between basic science, clinical trials, and patient care in Alzheimer's disease. THE LANCET. HEALTHY LONGEVITY 2022; 3:e797-e803. [PMID: 36356629 DOI: 10.1016/s2666-7568(22)00219-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 11/09/2022] Open
Abstract
Both research and clinical practice have traditionally centred on the dementia syndrome of Alzheimer's disease rather than its preclinical and prodromal stages. However, there is a strong scientific and ethical impetus to shift focus to earlier disease stages to improve brain health outcomes and help to keep affected individuals symptom-free (dementia-free) for as long as possible. We provide an overview of recent advancements in early detection, drug development, and trial methodology that should be utilised in the development of new therapies for use in brain health clinics. We propose a triad approach to Alzheimer's disease clinical trials, encompassing (1) experimental medicine studies to gather greater knowledge of disease mechanisms, (2) a more comprehensive platform of phase 2 learning trials to inform phase 3 confirmatory trials, and (3) precision medicine involving smaller subgroups of patients with shared characteristics. This triad would ensure that treatment targets are identified accurately, trial methodology focuses on at-risk populations, and sensitive outcome measures capture potential treatment effects. Clinical services around the world must embrace the brain health clinic model so that neurodegenerative diseases can be detected in their earliest phase to quicken drug development pipelines and potentially improve prognosis.
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Affiliation(s)
- Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatient Department 2, Western General Hospital, University of Edinburgh, Edinburgh, UK.
| | - Stina Saunders
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatient Department 2, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, Outpatient Department 2, Western General Hospital, University of Edinburgh, Edinburgh, UK; Brain Health Scotland, Edinburgh, UK
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Alhassan M, Hovis JK, Almeida QJ. Visual processing speed in freezing and non-freezing Parkinson's disease patients. Clin Park Relat Disord 2020; 3:100060. [PMID: 34316642 PMCID: PMC8298779 DOI: 10.1016/j.prdoa.2020.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/26/2020] [Accepted: 05/24/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Parkinson's disease patients are usually characterized by body motor dysfunction due to dopaminergic reduction in the central nervous system. Freezing of gait is a motor disorder that affects certain Parkinson's disease patients. However, it is hypothesized that non-motor functions mediated by the cholinergic system are also involved in developing freezing of gait. Visual information processing speed, or inspection time is independent of the motor response, and can be used a reliable measure of the cholinergic system integrity. Objective Inspection time can be used to investigate whether Parkinson's disease patients with freezing of gait symptoms have a larger impairment in cholinergic mediated functions than those patients who have no freezing of gait symptoms and healthy controls. Methods The inspection time was determined by a simple length discrimination task. Twenty-two Parkinson's disease patients with freezing of gait, 25 Parkinson's disease patients without freezing of gait, and 25 aged matched healthy controls participated in the study. Results Based on the log values of IT score, Parkinson's disease patients with freezing of gait symptoms had statistically significant slower inspection times (mean of 1.793 ms) than Parkinson's disease patients without freezing of gait (mean of 1.655 ms) and healthy controls (mean of 1.523 ms). Inspection times for the Parkinson's disease patients without FOG symptoms were also significantly slower than healthy controls. Conclusion The results of this study support the hypothesis that the cholinergic system integrity is affected more in Parkinson's disease patients with freezing of gait symptoms. Non-motor symptoms are associated with Parkinson’s disease patients. Inspection time can be used as a reliable tool to evaluate the integrity of the cholinergic system. Patients with Parkinson’s disease especially those who showed freezing of gait symptoms had longer inspection time score which suggest they have deficit in the cholinergic system.
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Key Words
- ANOVA, analysis of variance
- FOG PD, Parkinson's disease patients with freezing of gait symptoms
- FOG, freezing of gait
- Freezing of gait
- HC, healthy controls
- IT, inspection time
- Inspection time
- MoCA, Montreal Cognitive Assessment Test
- Non-FOG PD, Parkinson's disease patients without freezing of gait symptoms
- Non-FOG, non-freezing of gait
- Non-motor symptom
- PD, Parkinson's disease
- Parkinson's disease
- RT, reaction time
- UPDRS, Unified Parkinson's disease Rating Scale
- Visual perception
- Visual speed processing
- mesc, millisecond
- nAChRs, nicotine acetylcholine receptors
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Affiliation(s)
- Mosaad Alhassan
- Department of Optometry & Vision Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Jeffery K Hovis
- School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Quincy J Almeida
- Sun Life Financial Movement Disorders Research and Rehabilitation Center (MDRC), Wilfrid Laurier University, Waterloo, ON, Canada
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3
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Simpraga S, Mansvelder HD, Groeneveld GJ, Prins S, Hart EP, Poil SS, Linkenkaer-Hansen K. An EEG nicotinic acetylcholine index to assess the efficacy of pro-cognitive compounds. Clin Neurophysiol 2018; 129:2325-2332. [DOI: 10.1016/j.clinph.2018.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 06/27/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022]
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Alvarez-Jimenez R, Hart EP, Prins S, de Kam M, van Gerven JMA, Cohen AF, Groeneveld GJ. Reversal of mecamylamine-induced effects in healthy subjects by nicotine receptor agonists: Cognitive and (electro) physiological responses. Br J Clin Pharmacol 2018; 84:888-899. [PMID: 29319910 DOI: 10.1111/bcp.13507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 12/24/2017] [Accepted: 12/31/2017] [Indexed: 11/27/2022] Open
Abstract
AIMS Establishing a pharmacological challenge model could yield an important tool to understand the complex role of the nicotinic cholinergic system in cognition and to develop novel compounds acting on the nicotinic acetylcholine receptor. METHODS This randomized, double-blind, double-dummy, placebo-controlled, four-way crossover study examined the effects of the nicotinic antagonist mecamylamine on a battery of cognitive and neurophysiological test with coadministration of a placebo, nicotine or galantamine in order to reverse the cognitive impairment caused by mecamylamine. RESULTS Thirty-three healthy subjects received a single oral dose of 30 mg of mecamylamine (or placebo) in combination with either 16 mg of oral galantamine or 21 mg of transdermal nicotine (or its double-dummy). Mecamylamine 30 mg induced significant disturbances of cognitive functions. Attention and execution of visual (fine) motor tasks was decreased, short- and long-term memory was impaired and the reaction velocity during the test was slower when compared to placebo. Mecamylamine 30 mg produced a decrease in posterior α and β power in the surface electroencephalogram, effects that were reversed by nicotine coadministration. Memory and motor coordination tests could be partially reversed by the coadministration of nicotine. CONCLUSIONS Mecamylamine administration induced slowing of the electroencephalogram and produced decrease in performance of tests evaluating motor coordination, sustained attention and short- and long-term memory. These effects could be partially reversed by the coadministration of nicotine, and to a lesser extent by galantamine.
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Affiliation(s)
- Ricardo Alvarez-Jimenez
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands.,Anesthesiology Department, Vrije Universiteit Medisch Centrum (VU University Medical Center), De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Ellen P Hart
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands
| | - Samantha Prins
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands
| | - Marieke de Kam
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands
| | - Joop M A van Gerven
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands.,Neurology Department, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Adam F Cohen
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands.,Internal Medicine Department, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, The Netherlands
| | - Geert Jan Groeneveld
- Centre for Human Drug Research, Zernikedreef 8, 2333, CL, Leiden, The Netherlands.,Neurology Department, VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
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5
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Baakman AC, Alvarez‐Jimenez R, Rissmann R, Klaassen ES, Stevens J, Goulooze SC, den Burger JCG, Swart EL, van Gerven JMA, Groeneveld GJ. An anti-nicotinic cognitive challenge model using mecamylamine in comparison with the anti-muscarinic cognitive challenge using scopolamine. Br J Clin Pharmacol 2017; 83:1676-1687. [PMID: 28217868 PMCID: PMC5510063 DOI: 10.1111/bcp.13268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 01/06/2023] Open
Abstract
AIMS The muscarinic acetylcholine receptor antagonist scopolamine is often used for proof-of-pharmacology studies with pro-cognitive compounds. From a pharmacological point of view, it would seem more rational to use a nicotinic rather than a muscarinic anticholinergic challenge to prove pharmacology of a nicotinic acetylcholine receptor agonist. This study aims to characterize a nicotinic anticholinergic challenge model using mecamylamine and to compare it to the scopolamine model. METHODS In this double-blind, placebo-controlled, four-way cross-over trial, 12 healthy male subjects received oral mecamylamine 10 and 20 mg, intravenous scopolamine 0.5 mg and placebo. Pharmacokinetics were analysed using non-compartmental analysis. Pharmacodynamic effects were measured with a multidimensional test battery that includes neurophysiological, subjective, (visuo)motor and cognitive measurements. RESULTS All treatments were safe and well tolerated. Mecamylamine had a tmax of 2.5 h and a Cmax of 64.5 ng ml-1 for the 20 mg dose. Mecamylamine had a dose-dependent effect decreasing the adaptive tracking performance and VAS alertness, and increasing the finger tapping and visual verbal learning task performance time and errors. Scopolamine significantly affected almost all pharmacodynamic tests. CONCLUSION This study demonstrated that mecamylamine causes nicotinic receptor specific temporary decline in cognitive functioning. Compared with the scopolamine model, pharmacodynamic effects were less pronounced at the dose levels tested; however, mecamylamine caused less sedation. The cognitive effects of scopolamine might at least partly be caused by sedation. Whether the mecamylamine model can be used for proof-of-pharmacology of nicotinic acetylcholine receptor agonists remains to be established.
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Affiliation(s)
| | | | | | | | | | | | - Jeroen C. G. den Burger
- Department of Clinical Pharmacology and PharmacyVU University Medical CenterAmsterdamThe Netherlands
| | - Eleonora L. Swart
- Department of Clinical Pharmacology and PharmacyVU University Medical CenterAmsterdamThe Netherlands
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6
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Alvarez-Jimenez R, Baakman AC, Stevens J, Goulooze SC, Hart EP, Rissmann R, van Gerven JM, Groeneveld GJ. Pharmacokinetics and pharmacodynamics of oral mecamylamine - development of a nicotinic acetylcholine receptor antagonist cognitive challenge test using modelling and simulation. J Psychopharmacol 2017; 31:192-203. [PMID: 27927703 DOI: 10.1177/0269881116681417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A pharmacologic challenge model with a nicotinic antagonist could be an important tool not only to understand the complex role of the nicotinic cholinergic system in cognition, but also to develop novel compounds acting on the nicotinic acetylcholine receptor. The objective was to develop a pharmacokinetic-pharmacodynamic (PKPD) model using nonlinear mixed effects (NLME) methods to quantitate the pharmacokinetics of three oral mecamylamine doses (10, 20 and 30 mg) and correlate the plasma concentrations to the pharmacodynamic effects on a cognitive and neurophysiologic battery of tests in healthy subjects. A one-compartment linear kinetic model best described the plasma concentrations of mecamylamine. Mecamylamine's estimated clearance was 0.28 ± 0.015 L min-1. The peripheral volume of distribution (291 ± 5.15 L) was directly related to total body weight. Mecamylamine impaired the accuracy and increased the reaction time in tests evaluating short term working memory with a steep increase in the concentration-effect relationship at plasma concentrations below 100 μg L-1. On the other hand, mecamylamine induced a decrease in performance of tests evaluating visual and fine motor coordination at higher plasma concentrations (EC50 97 μg L-1). Systolic and diastolic blood pressure decreased exponentially after a plasma mecamylamine concentration of 80 μg L-1, a known effect previously poorly studied in healthy subjects. The developed mecamylamine PKPD model was used to quantify the effects of nicotinic blockade in a set of neurophysiological tests in humans with the goal to provide insight into the physiology and pharmacology of the nicotinic system in humans and the possibility to optimize future trials that use mecamylamine as a pharmacological challenge.
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Affiliation(s)
| | | | - Jasper Stevens
- 1 Centre for Human Drug Research, Leiden, the Netherlands
| | - Sebastiaan C Goulooze
- 1 Centre for Human Drug Research, Leiden, the Netherlands.,2 Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Ellen P Hart
- 1 Centre for Human Drug Research, Leiden, the Netherlands
| | | | - Joop Ma van Gerven
- 1 Centre for Human Drug Research, Leiden, the Netherlands.,3 Neurology Department, Leiden University Medical Centre, Leiden, the Netherlands
| | - Geert Jan Groeneveld
- 1 Centre for Human Drug Research, Leiden, the Netherlands.,4 Neurology Department, VU University Medical Centre, Amsterdam, the Netherlands
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Sugihara H, Chen N, Sur M. Cell-specific modulation of plasticity and cortical state by cholinergic inputs to the visual cortex. JOURNAL OF PHYSIOLOGY, PARIS 2016; 110:37-43. [PMID: 27840211 PMCID: PMC5769868 DOI: 10.1016/j.jphysparis.2016.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022]
Abstract
Acetylcholine (ACh) modulates diverse vital brain functions. Cholinergic neurons from the basal forebrain innervate a wide range of cortical areas, including the primary visual cortex (V1), and multiple cortical cell types have been found to be responsive to ACh. Here we review how different cell types contribute to different cortical functions modulated by ACh. We specifically focus on two major cortical functions: plasticity and cortical state. In layer II/III of V1, ACh acting on astrocytes and somatostatin-expressing inhibitory neurons plays critical roles in these functions. Cell type specificity of cholinergic modulation points towards the growing understanding that even diffuse neurotransmitter systems can mediate specific functions through specific cell classes and receptors.
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Affiliation(s)
- Hiroki Sugihara
- Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Naiyan Chen
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Laboratory of Metabolic Medicine, Singapore Bioimaging Consortium, A(∗)STAR, Republic of Singapore
| | - Mriganka Sur
- Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Lucas N, Saj A, Schwartz S, Ptak R, Thomas C, Conne P, Leroy R, Pavin S, Diserens K, Vuilleumier P. Effects of pro-cholinergic treatment in patients suffering from spatial neglect. Front Hum Neurosci 2013; 7:574. [PMID: 24062674 PMCID: PMC3771310 DOI: 10.3389/fnhum.2013.00574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 08/27/2013] [Indexed: 11/13/2022] Open
Abstract
Spatial neglect is a neurological condition characterized by a breakdown of spatial cognition contralateral to hemispheric damage. Deficits in spatial attention toward the contralesional side are considered to be central to this syndrome. Brain lesions typically involve right fronto-parietal cortices mediating attentional functions and subcortical connections in underlying white matter. Convergent findings from neuroimaging and behavioral studies in both animals and humans suggest that the cholinergic system might also be critically implicated in selective attention by modulating cortical function via widespread projections from the basal forebrain. Here we asked whether deficits in spatial attention associated with neglect could partly result from a cholinergic deafferentation of cortical areas subserving attentional functions, and whether such disturbances could be alleviated by pro-cholinergic therapy. We examined the effect of a single-dose transdermal nicotine treatment on spatial neglect in 10 stroke patients in a double-blind placebo-controlled protocol, using a standardized battery of neglect tests. Nicotine-induced systematic improvement on cancellation tasks and facilitated orienting to single visual targets, but had no significant effect on other tests. These results support a global effect of nicotine on attention and arousal, but no effect on other spatial mechanisms impaired in neglect.
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Affiliation(s)
- N Lucas
- Neuroscience Department, Laboratory for Behavioral Neurology and Imaging of Cognition, University of Geneva , Geneva , Switzerland
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Ginani GE, Tufik S, Bueno OFA, Pradella-Hallinan M, Rusted J, Pompéia S. Acute effects of donepezil in healthy young adults underline the fractionation of executive functioning. J Psychopharmacol 2011; 25:1508-16. [PMID: 21262858 DOI: 10.1177/0269881110391832] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The cholinergic system is involved in the modulation of both bottom-up and top-down attentional control. Top-down attention engages multiple executive control processes, but few studies have investigated whether all or selective elements of executive functions are modulated by the cholinergic system. To investigate the acute effects of the pro-cholinergic donepezil in young, healthy volunteers on distinct components of executive functions we conducted a double-blind, placebo-controlled, independent-groups design study including 42 young healthy male participants who were randomly assigned to one of three oral treatments: glucose (placebo), donepezil 5 mg or donepezil 7.5 mg. The test battery included measures of different executive components (shifting, updating, inhibition, dual-task performance, planning, access to long-term memory), tasks that evaluated arousal/vigilance/visuomotor performance, as well as functioning of working memory subsidiary systems. Donepezil improved sustained attention, reaction times, dual-task performance and the executive component of digit span. The positive effects in these executive tasks did not correlate with arousal/visuomotor/vigilance measures. Among the various executive domains investigated donepezil selectively increased dual-task performance in a manner that could not be ascribed to improvement in arousal/vigilance/visuomotor performance nor working memory slave systems. Other executive tasks that rely heavily on visuospatial processing may also be modulated by the cholinergic system.
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Affiliation(s)
- G E Ginani
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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10
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Prompt but inefficient: nicotine differentially modulates discrete components of attention. Psychopharmacology (Berl) 2011; 218:667-80. [PMID: 21629997 PMCID: PMC3222829 DOI: 10.1007/s00213-011-2361-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/16/2011] [Indexed: 11/02/2022]
Abstract
RATIONALE Nicotine has been shown to improve both memory and attention when assessed through speeded motor responses. Since very few studies have assessed effects of nicotine on visual attention using measures that are uncontaminated by motoric effects, nicotine's attentional effects may, at least partially, be due to speeding of motor function. OBJECTIVES Using an unspeeded, accuracy-based test, the CombiTVA paradigm, we examined whether nicotine enhances attention when it is measured independently of motor processing. METHODS We modelled data with a computational theory of visual attention (TVA; Bundesen 1990) so as to derive independent estimates of several distinct components of attention from performance of the single task: threshold of visual perception, perceptual processing speed, visual short-term memory storage capacity and top-down controlled selectivity. Acute effects of nicotine (2 mg gum) on performance were assessed in 24 healthy young non-smokers in a placebo-controlled counterbalanced, crossover design. Chronic effects of nicotine were investigated in 24 age- and education-matched minimally deprived smokers. RESULTS Both an acute dose of nicotine in non-smokers and chronic nicotine use in temporarily abstaining smokers improved perceptual thresholds but slowed subsequent perceptual speed. Moreover, both acute and chronic nicotine use reduced attentional selectivity though visual short-term memory capacity was unimpaired. CONCLUSIONS Nicotine differentially affected discrete components of visual attention, with acute and chronic doses revealing identical patterns of performance. We challenge prior reports of nicotine-induced speeding of information processing by showing, for the first time, that nicotine slows down perceptual processing speed when assessed using accuracy-based measures of cognitive performance.
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Cognitive performance and cholinergic transmission: influence of muscarinic and nicotinic receptor blockade. Eur Arch Psychiatry Clin Neurosci 2010; 260 Suppl 2:S106-10. [PMID: 20960003 DOI: 10.1007/s00406-010-0160-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 09/23/2010] [Indexed: 01/12/2023]
Abstract
The cholinergic system is essential in mediating cognitive processes. Although there has been extensive research regarding cholinergic receptor subsystems, the specific contribution of the muscarinic and nicotinic receptor system to cognitive processes still has not been sufficiently explored. In the present study, we examined the selective contribution of muscarinic and nicotinic antagonism to cognitive performance in healthy human subjects. A single-blind, double-dummy, time-elapsed, repeated measures cross-over design was used on 15 healthy males. Subjects completed a neuropsychological test battery assessing a wide range of cognitive domains after 0.4 mg scopolamine (intravenous), 0.2 mg/kg mecamylamine (max. 15 mg; oral) or placebo. Subjects were tested under three conditions: placebo/placebo (PP), scopolamine/placebo (SP) and mecamylamine/placebo (MP). Results show that scopolamine significantly impaired the free recall and recognition performance in the verbal learning test. No other cognitive domain was affected, neither by scopolamine nor by mecamylamine. In line with the existing literature, antagonism of muscarinic receptors resulted in specific cognitive impairments, predominantly memory performance.
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12
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Ellis J, Nathan P, Villemagne V, Mulligan R, Ellis K, Tochon-Danguy H, Chan J, O'keefe G, Bradley J, Savage G, Rowe C. The relationship between nicotinic receptors and cognitive functioning in healthy aging: An in vivo positron emission tomography (PET) study with 2-[18F]fluoro-A-85380. Synapse 2009; 63:752-63. [DOI: 10.1002/syn.20642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Zaninotto ALC, Bueno OFA, Pradella-Hallinan M, Tufik S, Rusted J, Stough C, Pompéia S. Acute cognitive effects of donepezil in young, healthy volunteers. Hum Psychopharmacol 2009; 24:453-64. [PMID: 19637397 DOI: 10.1002/hup.1044] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The acute nootropic potential of donepezil in young healthy volunteers has not been adequately investigated mainly because in previous studies: (1) effects were assessed before peak-plasma concentration (Tmax) was reached; (2) only a few cognitive processes were assessed. Here we investigated a myriad of cognitive effects of augmentation of acetylcholine using an acute dose of donepezil in healthy adults at theoretical Tmax. METHODS This was a double-blind, placebo controlled, parallel group design study of cognitive effects of acute oral donepezil (5 mg). Subjects were tested twice after donepezil ingestion: 90 min (time that coincides with previous testing in the literature) and 210 min. (theoretical Tmax). The test battery included tasks that tap cognitive domains that are sensitive to acetylcholine manipulations. RESULTS At both testing times donepezil improved long-term recall of prose, objects recall, recall of spatial locations, and integration of objects with their locations, some effects having been related to self-reported mood enhancement. However, improvement of performance in the central executive measure (backward digit span) occurred only at Tmax. CONCLUSION Positive cognitive effects of acute donepezil can be observed in various cognitive domains including mood, but its full nootropic potential is more clearly found close to theoretical peak-plasma concentration.
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Affiliation(s)
- Ana L C Zaninotto
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
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14
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Ellis JR, Nathan PJ, Villemagne VL, Mulligan RS, Saunder T, Young K, Smith CL, Welch J, Woodward M, Wesnes KA, Savage G, Rowe CC. Galantamine-induced improvements in cognitive function are not related to alterations in alpha(4)beta (2) nicotinic receptors in early Alzheimer's disease as measured in vivo by 2-[18F]fluoro-A-85380 PET. Psychopharmacology (Berl) 2009; 202:79-91. [PMID: 18949462 DOI: 10.1007/s00213-008-1347-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 09/19/2008] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The nicotinic acetylcholine receptor (nAChR) system plays a regulatory role in a number of cognitive processes. Cholinesterase inhibitors (i.e., galantamine) that potentiate cholinergic neurotransmission improve cognitive function in Alzheimer's disease (AD); however, the relationship between these effects and associated changes in nAChRs are yet to be established in vivo. MATERIALS AND METHODS 2-[18F]Fluoro-A-85380 (2-FA) binds to nAChRs and with positron emission tomography (PET) imaging provides a composite measure of receptor density and ligand affinity. This study aimed to: (1) quantify nAChRs in vivo in 15 drug-naïve patients with mild AD before and after chronic treatment with galantamine, using 2-FA and PET, and (2) examine the relationship between treatment-induced changes in nAChRs and improvements in cognitive function. Participants were nonsmokers and underwent extensive cognitive testing and a PET scan after injection of approximately 200 MBq of 2-FA on two occasions (before and after 12 weeks, galantamine treatment). A 3-day washout period preceded the second scan. Brain regional 2-FA binding was assessed through a simplified estimation of distribution volume (DV(S)). RESULTS Performance on global measures of cognition significantly improved following galantamine treatment (p < 0.05). This improvement extended to specific cognitive measures of language and verbal learning. No significant differences in nAChR DV(S) before and after galantamine treatment were found. The treatment-induced improvement in cognition was not correlated with regional or global nAChR DV(S), suggesting that changes in nAChRs may not be responsible for the improvements in cognition following galantamine in patients with mild AD.
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Affiliation(s)
- J R Ellis
- School of Psychology, Psychiatry, and Psychological Medicine, Monash University, Melbourne, Victoria, Australia.
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Sobrio F, Debruyne D, Dhilly M, Chazalviel L, Camsonne R, Kakiuchi T, Tsukada H, Barré L. Evaluation in rats and primates of [11C]-mecamylamine, a potential nicotinic acetylcholine receptor radioligand for positron emission tomography. Neurochem Int 2005; 46:479-88. [PMID: 15769550 DOI: 10.1016/j.neuint.2004.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 12/03/2004] [Accepted: 12/14/2004] [Indexed: 12/01/2022]
Abstract
Mecamylamine is a well-described non specific antagonist of nicotinic acetylcholine receptors (nAChRs), used in therapy and in psychopharmacological studies. [(11)C]-Mecamylamine was prepared and evaluated as a putative radioligand for positron emission tomography to study nicotinic acetylcholine receptors. The radiosynthesis consisted in the [(11)C]-methylation of the desmethyl precursor within 40 min with 30-40% radiochemical yield decay corrected. Biodistribution studies in rats showed that radioligand crossed the blood-brain barrier (0.39% ID at 30 min) and only unmetabolized tracer was recovered from brain at 45 min. Ex vivo autoradiography studies in rats did not indicate preferential uptake, and pre-treatment mecamylamine or with chlorisondamine, an nicotinic receptor inhibitor, did not demonstrate a significant specific binding. To investigate possible specie differences and effects of anesthesia, in vivo positron emission tomography (PET) studies were carried out on anaesthetized baboons and conscious macaques. The regional brain distribution of [(11)C]-mecamylamine in the two species of primates exhibited similar kinetics as did the rat with steady state reached about 45-50 min after radiotracer administration. Uptake values were two-fold higher in brain of conscious macaque than in anaesthetized baboon (thalamus: 0.258% ID/(kg mL) in conscious macaques and 0.129% ID/(kg mL) in baboons). PET images showed a radioactivity distribution which was quite homogeneous throughout the brain but with somewhat higher uptake in grey matter than in white. Brain distribution was unaltered by saturation or displacement studies. Possible explanation for the failure to establish specific binding in vivo could be long-lived structural modifications of the ionotropic channel by the unlabeled ligand administered before the tracer. In conclusion, [(11)C]-mecamylamine did not satisfy the requirements for a PET tracer of nicotinic acetylcholine receptors.
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Affiliation(s)
- Franck Sobrio
- DRM-DSV-CEA - UMR CEA FRE CNRS 2698, Centre Cyceron, BP 5229, F-14074 Caen, France.
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Wilkinson DG, Francis PT, Schwam E, Payne-Parrish J. Cholinesterase inhibitors used in the treatment of Alzheimer's disease: the relationship between pharmacological effects and clinical efficacy. Drugs Aging 2004; 21:453-78. [PMID: 15132713 DOI: 10.2165/00002512-200421070-00004] [Citation(s) in RCA: 220] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The deficiency in cholinergic neurotransmission in Alzheimer's disease has led to the development of cholinesterase inhibitors as the first-line treatment for symptoms of this disease. The clinical benefits of these agents include improvements, stabilisation or less than expected decline in cognition, function and behaviour. The common mechanism of action underlying this class of agents is an increase in available acetylcholine through inhibition of the catabolic enzyme, acetylcholinesterase. There is substantial evidence that the cholinesterase inhibitors, including donepezil, galantamine and rivastigmine, decrease acetylcholinesterase activity in a number of brain regions in patients with Alzheimer's disease. There is also a significant correlation between acetylcholinesterase inhibition and observed cognitive improvement. However, the cholinesterase inhibitors are reported to have additional pharmacological actions. Rivastigmine inhibits butyrylcholinesterase with a similar affinity to acetylcholinesterase, although it is not clear whether the inhibition of butyrylcholinesterase contributes to the therapeutic effect of rivastigmine. Based on data from preclinical studies, it has been proposed that galantamine also potentiates the action of acetylcholine on nicotinic receptors via allosteric modulation; however, the effects appear to be highly dependent on the concentrations of agonist and galantamine. It is not yet clear whether these concentrations are related to those achieved in the brain of patients with Alzheimer's disease within therapeutic dose ranges. Preclinical studies have shown that donepezil and galantamine also significantly increase nicotinic receptor density, and increased receptor density may be associated with enhanced synaptic strengthening through long-term potentiation, which is related to cognitive function. Despite these differences in pharmacology, a review of clinical data, including head-to-head studies, has not demonstrated differences in efficacy, although they may have an impact on tolerability. It seems clear that whatever the subsidiary modes of action, clinical evidence supporting acetylcholinesterase inhibition as the mechanism by which cholinesterase inhibitors treat the symptoms of Alzheimer's disease is accumulating. Certainly, as a class, the currently approved cholinesterase inhibitors (donepezil, galantamine, rivastigmine and tacrine) provide important benefits in patients with Alzheimer's disease and these drugs offer a significant advance in the management of dementia.
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Affiliation(s)
- David G Wilkinson
- Memory Assessment and Research Centre, Moorgreen Hospital, Southampton, UK.
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Johnson AM, Almeida QJ, Stough C, Thompson JC, Singarayer R, Jog MS. Visual inspection time in Parkinson’s disease: deficits in early stages of cognitive processing. Neuropsychologia 2004; 42:577-83. [PMID: 14725796 DOI: 10.1016/j.neuropsychologia.2003.10.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Inspection time (IT) is a simple information processing paradigm dependent on a participant's ability to identify physical properties of a stimulus presented for a specified time interval. In contrast with reaction time (RT) studies, the dependent variable of interest in IT is not related to the motoric speed with which the individual is able to respond, but rather the minimum presentation time necessary for participants to reliably identify physical properties of the stimulus. It is well documented that individuals with Parkinson's disease (PD) experience significant impairment on tests of simple RT, but it is unclear whether such deficits can be interpreted as 'pure' slowness of information processing, or a delay in the selection and output of a motor response. In the first experiment described here, a sample of 'optimally medicated' PD patients was compared with an age-matched control group, on an IT task. Results of this experiment suggested that individuals with PD required significantly longer stimulus presentation times than healthy participants. The second experiment compared a sample of PD patients (tested both "ON" and "OFF" their typical dopaminergic medications), with an age-matched control group, on the same test of IT. Results again indicated a significant IT deficit in participants with PD, and suggested that these deficits do not significantly resolve with levodopa treatment. Overall, the results of these two experiments suggest that information processing deficits associated with PD are distinct from motor impairment. These findings are further discussed in terms of existing neurochemical models of information processing ability.
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Affiliation(s)
- Andrew M Johnson
- Faculty of Health Sciences, University of Western Ontario, Ont., N6A 3K7, London, Canada.
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Debruyne D, Sobrio F, Hinschberger A, Camsonne R, Coquerel A, Barré L. Short-term pharmacokinetics and brain distribution of mecamylamine as a preliminary to carbon-11 labeling for nicotinic receptor investigation. J Pharm Sci 2003; 92:1051-7. [PMID: 12712425 DOI: 10.1002/jps.10302] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
As a preliminary to development and evaluation of labeled mecamylamine as a potential in vivo imaging ligand for human central nicotinic receptors (nAchRs), this work was intended to determine whether the pharmacokinetic properties of mecamylamine are suitable for experimental studies using (11)C-radiolabeled mecamylamine preliminary to positron emission tomography (PET) in humans. An original gas chromatographic method for rapid and simple determination of mecamylamine in biological samples was developed and validated (within run precision, 3.8-5.2%; between assay variation, 5.3-6.9%; assay accuracy, 5.6-11.8%). The results of the pharmacokinetic investigation in the rat demonstrated a very fast clearance of mecamylamine from blood [half-life, 1.2 h; clearance (CL), 1.2 L/kg/h) concomitant with an uptake that was higher in kidney, intermediate in lung, and lower in heart, liver, and brain. Brain tissue kinetics of mecamylamine showed a similar pattern for all the regions, with a rapid increase followed by a plateau after 15 min. This plateau differed according to the region of the brain; it was higher in colliculi, hippocampus, and cortex (area of high density of nAchRs) than in cerebellum or white matter (area with a limited population of nAchRs). No other lipophilic metabolites that were able to disturb the specific binding to nAchRs were identified during the investigation. Thus, mecamylamine shows peculiar qualities making it a good candidate for carbon-11 labeling for experimental studies in view of final PET imaging.
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Affiliation(s)
- D Debruyne
- Laboratory of Pharmacology, CHU Côte de Nacre, 14032 Caen cedex, France.
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Abstract
RATIONALE The acute administration of nicotine via a cigarette has been demonstrated to enhance inspection time (IT), a measure of rapid visual information processing, while the nicotinic antagonist mecamylamine impairs IT. However, as transdermal nicotine patches provide a slow delivery of nicotine, it is unclear if they produce similar effects to nicotine administered by more rapid methods. OBJECTIVES To examine the effects of transdermal nicotine on inspection time. METHODS Ten moderate smokers were administered nicotine (21 mg/day) or placebo via a transdermal patch in a randomized, double-blind, repeated measures design. Subjects were administered the IT task at baseline, then 1, 3, and 6 h subsequent to patch application. RESULTS The change in IT from baseline was significantly different in the nicotine condition, relative to placebo, at 3 h but not 1 or 6 h. CONCLUSIONS The findings suggest that nicotine administered via transdermal patches improves IT, but this improvement may be subject to tolerance. Data from previous studies on tolerance to the cognitive effects of nicotine have been inconclusive. However, the slow delivery of nicotine from patches may be more likely to produce such effects.
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Affiliation(s)
- J C Thompson
- Brain Sciences Institute, Swinburne University, Hawthorn, Vic, Australia
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Nathan PJ, Stough C. Inspection time: a neuropsychophysiological test for measuring the functional integrity of the cholinergic system. Med Hypotheses 2001; 57:759-60. [PMID: 11918442 DOI: 10.1054/mehy.2001.1484] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inspection time (IT) is a measure of the speed of early information processing, demonstrating reliable correlation with psychometric intelligence. We now provide evidence that it may serve as a marker for the integrity of the cholinergic system. Cholinergic agonists improve and antagonists impair IT, while modulators of the monoamine systems are without effect. Furthermore impairments in IT correlate with disease severity in Alzheimer's disease, a disorder of compromised cholinergic system function. Taken together, available data suggest that IT may be a useful physiological marker of functional status of the cholinergic system.
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Affiliation(s)
- P J Nathan
- Neuropharmacology Laboratory Brain Sciences Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia.
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Deary IJ, Simonotto E, Marshall A, Marshall I, Goddard N, Wardlaw JM. The functional anatomy of inspection time: a pilot fMRI study. INTELLIGENCE 2001. [DOI: 10.1016/s0160-2896(01)00076-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Stough C, Thompson J, Bates T, Nathan P. Examining neurochemical determinants of inspection time. INTELLIGENCE 2001. [DOI: 10.1016/s0160-2896(01)00077-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nathan PJ, Baker A, Carr E, Earle J, Jones M, Nieciecki M, Hutchison C, Stough C. Cholinergic modulation of cognitive function in healthy subjects: acute effects of donepezil, a cholinesterase inhibitor. Hum Psychopharmacol 2001; 16:481-483. [PMID: 12404557 DOI: 10.1002/hup.323] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pradeep J. Nathan
- Neuropharmacology Laboratory, Brain Sciences Institute, Hawthorn, Victoria, Australia
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Deary IJ. Human intelligence differences: towards a combined experimental-differential approach. Trends Cogn Sci 2001; 5:164-170. [PMID: 11287270 DOI: 10.1016/s1364-6613(00)01623-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Despite the fact that much is known about the taxonomy and predictive validity of human intelligence differences, there has been relatively little progress in understanding their cognitive bases. However, some recent firm findings mark the beginnings of a cognitive reductionism in human intelligence. Progress towards discovering 'cognitive components' that, firstly, show individual differences and, secondly, relate to psychometric intelligence differences is described here at different nominal levels of analysis: 'psychometric', 'cognitive-experimental' and 'psychophysical'. The field of intelligence differences remains a fertile yet seriously under-developed demesne in which cognitive scientists should collaborate with differential psychologists.
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Affiliation(s)
- I J. Deary
- Department of Psychology, University of Edinburgh, 7 George Square, EH8 9JZ, Edinburgh, UK
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