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Colwell MJ, Tagomori H, Chapman S, Gillespie AL, Cowen PJ, Harmer CJ, Murphy SE. Pharmacological targeting of cognitive impairment in depression: recent developments and challenges in human clinical research. Transl Psychiatry 2022; 12:484. [PMID: 36396622 PMCID: PMC9671959 DOI: 10.1038/s41398-022-02249-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Impaired cognition is often overlooked in the clinical management of depression, despite its association with poor psychosocial functioning and reduced clinical engagement. There is an outstanding need for new treatments to address this unmet clinical need, highlighted by our consultations with individuals with lived experience of depression. Here we consider the evidence to support different pharmacological approaches for the treatment of impaired cognition in individuals with depression, including treatments that influence primary neurotransmission directly as well as novel targets such as neurosteroid modulation. We also consider potential methodological challenges in establishing a strong evidence base in this area, including the need to disentangle direct effects of treatment on cognition from more generalised symptomatic improvement and the identification of sensitive, reliable and objective measures of cognition.
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Affiliation(s)
- Michael J Colwell
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Hosana Tagomori
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sarah Chapman
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Amy L Gillespie
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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Hossain S, Yousaf M, Liu Y, Chang D, Zhou X. An Overview of the Evidence and Mechanism of Drug-Herb Interactions Between Propolis and Pharmaceutical Drugs. Front Pharmacol 2022; 13:876183. [PMID: 35444531 PMCID: PMC9015648 DOI: 10.3389/fphar.2022.876183] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 12/18/2022] Open
Abstract
With the growing interest in the medicinal use of propolis, numerous studies have reported significant interactions between propolis extract and pharmaceutical drugs which may result in great clinical benefits or risks. The present study aims to review the drug-herb interactions of the full-spectrum propolis extract and main pharmaceutical drugs from the pharmacodynamic and pharmacokinetic aspects and elucidate the underlying pharmacological mechanisms. A literature search was conducted between June 2021 and February 2022 in Google Scholar, PubMed, MEDLINE, and EMBASE databases to include English studies from years 2000 to 2022 that evaluated the interaction of full-spectrum propolis extract and standard pharmaceutical drugs/cytochromes P450s. Studies that looked into geopropolis, propolis fractions, and isolated compounds, or interaction of propolis with foods, bioactive molecules, or receptors other than standard pharmaceutical drugs were excluded. From a pharmacodynamic perspective, propolis extract exhibited positive or synergistic interaction with several chemotherapeutic drugs by enhancing antitumor activity, sensitizing the chemoresistance cell lines, and attenuating multi-organ toxicity. The molecular mechanisms were associated with upregulating the apoptotic signal and immunomodulatory activity and attenuating oxidative damage. Propolis extract also enhanced the anti-bacterial and antifungal activities of many antimicrobial drugs against sensitive and resistant organisms, with an effect against the gram-positive bacteria stronger than that of the gram-negative bacteria. The synergistic action was related to strengthened action on interfering cell wall integrity and protein synthesis. The strong antioxidant activity of propolis also strengthened the therapeutic effect of metformin in attenuating hyperglycemia and pancreatic damage, as well as mitigating oxidative stress in the liver, kidney, and testis. In addition, propolis showed a potential capacity to enhance short-term and long-term memory function together with donepezil and improve motor function with levodopa and parasite killing activity with praziquantel. Pharmacokinetic studies showed inhibitory activities of propolis extracts on several CYP450 enzymes in vitro and in vivo. However, the effects on those CYP450 were deemed insignificant in humans, which may be attributed to the low bioavailability of the contributing bioactive compounds when administered in the body. The enhanced bioactivities of propolis and main pharmaceutical drugs support using propolis in integrative medicine in anti-cancer, anti-microbial, antidiabetic, and neurological disorders, with a low risk of altered pharmacokinetic activities.
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Affiliation(s)
- Sanowar Hossain
- Department of Pharmacy, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Muhammad Yousaf
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - Yang Liu
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Xian Zhou
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Péran P, Salabert AS, Dondaine T, Leclerc X, Gros-Dagnac H, Ranjeva JP, Lopes R, Lanteaume L, Blin O, Thalamas C, Bordet R, Payoux P. Functional connectivity and cognitive changes after donepezil treatment in healthy participants. Psychopharmacology (Berl) 2021; 238:3071-3082. [PMID: 34370064 DOI: 10.1007/s00213-021-05923-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
RATIONALE Donepezil is a potent, noncompetitive, reversible, clinically effective acetylcholinesterase inhibitor. The effects of this drug on healthy brains have seldom been investigated. OBJECTIVES The primary objective of the present study was to identify possible functional connectivity markers of the effect of donepezil in healthy young adult volunteers. METHODS The study had a double-blind, randomized, crossover design. 30 healthy adult volunteers underwent resting-state MRI scans during 15 days of donepezil or placebo treatment, in accordance with the design. RESULTS Results showed significant differences in intrinsic functional connectivity between donepezil and placebo, mainly in the right executive control network (RECN). More specifically, we found a decrease in the connectivity of the right inferior parietal node with other RECN nodes. Analysis using the cingulate cortex and parahippocampal regions as seeds also revealed complex modulation of functional connectivity in the donepezil condition. CONCLUSIONS In conclusion, donepezil treatment for 15 days may result in reorganization of resting-state networks, compared with placebo.
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Affiliation(s)
- P Péran
- Toulouse NeuroImaging Center (ToNIC), Université de Toulouse, INSERM, UPS, 31024, Toulouse Cedex 3, France.
| | - A S Salabert
- Toulouse NeuroImaging Center (ToNIC), Université de Toulouse, INSERM, UPS, 31024, Toulouse Cedex 3, France
| | - T Dondaine
- Degenerative & Vascular Cognitive Disorders Research Unit, INSERM-Lille University-Lille University Hospital, Lille, France
| | - X Leclerc
- Degenerative & Vascular Cognitive Disorders Research Unit, INSERM-Lille University-Lille University Hospital, Lille, France
| | - H Gros-Dagnac
- Toulouse NeuroImaging Center (ToNIC), Université de Toulouse, INSERM, UPS, 31024, Toulouse Cedex 3, France
| | - J-P Ranjeva
- Centre for Metabolic Exploration by Magnetic Resonance (CEMEREM), Aix-Marseille University-CNRS-CRMBM-Timone University Hospital, Marseille, France
| | - R Lopes
- Degenerative & Vascular Cognitive Disorders Research Unit, INSERM-Lille University-Lille University Hospital, Lille, France
| | - L Lanteaume
- Centre for Metabolic Exploration by Magnetic Resonance (CEMEREM), Aix-Marseille University-CNRS-CRMBM-Timone University Hospital, Marseille, France.,Department of Clinical Pharmacology (UPCET), Aix-Marseille University-INSERM-Timone University Hospital, Marseille, France
| | - O Blin
- Centre for Metabolic Exploration by Magnetic Resonance (CEMEREM), Aix-Marseille University-CNRS-CRMBM-Timone University Hospital, Marseille, France.,Department of Clinical Pharmacology (UPCET), Aix-Marseille University-INSERM-Timone University Hospital, Marseille, France
| | - C Thalamas
- Clinical Investigation Center (CIC1436), Toulouse, France
| | - R Bordet
- Degenerative & Vascular Cognitive Disorders Research Unit, INSERM-Lille University-Lille University Hospital, Lille, France
| | - P Payoux
- Toulouse NeuroImaging Center (ToNIC), Université de Toulouse, INSERM, UPS, 31024, Toulouse Cedex 3, France
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Marazziti D, Avella MT, Ivaldi T, Palermo S, Massa L, Vecchia AD, Basile L, Mucci F. Neuroenhancement: State of the Art and Future Perspectives. CLINICAL NEUROPSYCHIATRY 2021; 18:137-169. [PMID: 34909030 PMCID: PMC8629054 DOI: 10.36131/cnfioritieditore20210303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pharmacological neuroenhancement refers to the non-medical use of prescription drugs, alcohol, illegal drugs, or the so-called soft enhancers for the purpose of improving cognition, mood, pro-social behavior, or work and academic performance. This phenomenon is undoubtedly more frequent than previously supposed especially amongst university students. The aim of the present paper was to carefully review and comment on the available literature on neuroenhancement, according to Prisma guidelines. The results showed a great use of all prescribed drugs (benzodiazepines, antidepressants, antipsychotics, nootropic compounds, and especially stimulants) as neuroenhancers amongst healthy subjects, although probably the real prevalence is underestimated. The use of illicit drugs and soft enhancers is similarly quite common. Data on the improvement of cognition by other compounds, such as oxytocin and pheromones, or non-pharmacological techniques, specifically deep brain stimulation and transcranial magnetic stimulation, are still limited. In any case, if it is true that human beings are embedded by the desire to overcome the limits of their intrinsic nature, neuroenhancement practices put into question the concept of authenticity. Therefore, the problem appears quite complex and requires to be deepened and analyzed with no prejudice, although within an ethical conceptual frame.
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Affiliation(s)
- Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
- Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Maria Teresa Avella
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Tea Ivaldi
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Stefania Palermo
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Lucia Massa
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Alessandra Della Vecchia
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Lucia Basile
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Italy
| | - Federico Mucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Italy
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尼古丁对内隐记忆与外显记忆的影响 <sup>*</sup>. ACTA PSYCHOLOGICA SINICA 2018. [DOI: 10.3724/sp.j.1041.2018.00940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Exercise Intervention Associated with Cognitive Improvement in Alzheimer's Disease. Neural Plast 2018; 2018:9234105. [PMID: 29713339 PMCID: PMC5866875 DOI: 10.1155/2018/9234105] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/16/2018] [Indexed: 01/09/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease with the syndrome of cognitive and functional decline. Pharmacotherapy has always been in a dominant position for the treatment of AD. However, in most cases, drug therapy is accompanied with clinical delays when older adults have suffered from cognitive decline in episodic memory, working memory, and executive function. On the other hand, accumulating evidence suggests that exercise intervention may ameliorate the progression of cognitive impairment in aging ones while the standard strategy is lacking based on different levels of cognitive decline especially in mild cognitive impairment (MCI) and AD. MCI is the preclinical stage of AD in which neurodegeneration may be reversed via neuroplasticity. Therefore, taking exercise intervention in the early stage of MCI and healthy aging at the risk of AD could slow down the process of cognitive impairment and provide a promising cost-effective nonpharmacological therapy to dementia.
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Abstract
BACKGROUND Cognitive enhancement or neuroenhancement describes the increase in cognitive performance in humans by means of psychotropic drugs or brain stimulation methods, such as transcranial magnetic stimulation (TMS). PROBLEM This article discusses the potential of pharmacological cognitive enhancement with some of the most common drugs. METHODS A selective literature search was performed taking into account the most important groups of substances (i.e. caffeine, nicotine, stimulants including modafinil, and acetylcholine esterase inhibitors) for which studies on the pharmacological elevation of cognitive performance in healthy subjects are available. RESULTS The extent of the effects that can be pharmacologically achieved is essentially genetically determined. Some of the best-characterized polymorphisms are described here. Pharmacological enhancement of cognitive performance is currently possible with all of the compounds described here and caffeine and nicotine are used by millions of people without the explicit intention of most consumers of cognitive enhancement. DISCUSSION Clinical neuroscientists are required to share their expertise to a greater extent in the social discourse on cognitive enhancement in the future in order to influence opinion-forming and decision-making processes.
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Affiliation(s)
- G Gründer
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland,
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Differential effects of acute cortisol administration on deep and shallow episodic memory traces: A study on healthy males. Neurobiol Learn Mem 2014; 114:186-92. [DOI: 10.1016/j.nlm.2014.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/30/2014] [Accepted: 06/11/2014] [Indexed: 11/23/2022]
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Galli G. What makes deeply encoded items memorable? Insights into the levels of processing framework from neuroimaging and neuromodulation. Front Psychiatry 2014; 5:61. [PMID: 24904444 PMCID: PMC4035598 DOI: 10.3389/fpsyt.2014.00061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/15/2014] [Indexed: 01/17/2023] Open
Abstract
When we form new memories, their mnestic fate largely depends upon the cognitive operations set in train during encoding. A typical observation in experimental as well as everyday life settings is that if we learn an item using semantic or "deep" operations, such as attending to its meaning, memory will be better than if we learn the same item using more "shallow" operations, such as attending to its structural features. In the psychological literature, this phenomenon has been conceptualized within the "levels of processing" framework and has been consistently replicated since its original proposal by Craik and Lockhart in 1972. However, the exact mechanisms underlying the memory advantage for deeply encoded items are not yet entirely understood. A cognitive neuroscience perspective can add to this field by clarifying the nature of the processes involved in effective deep and shallow encoding and how they are instantiated in the brain, but so far there has been little work to systematically integrate findings from the literature. This work aims to fill this gap by reviewing, first, some of the key neuroimaging findings on the neural correlates of deep and shallow episodic encoding and second, emerging evidence from studies using neuromodulatory approaches such as psychopharmacology and non-invasive brain stimulation. Taken together, these studies help further our understanding of levels of processing. In addition, by showing that deep encoding can be modulated by acting upon specific brain regions or systems, the reviewed studies pave the way for selective enhancements of episodic encoding processes.
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Affiliation(s)
- Giulia Galli
- Brain Investigation and Neuromodulation (BIN) Laboratory, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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10
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Deguil J, Ravasi L, Auffret A, Babiloni C, Bartres Faz D, Bragulat V, Cassé-Perrot C, Colavito V, Herrero Ezquerro MT, Lamberty Y, Lanteaume L, Pemberton D, Pifferi F, Richardson JC, Schenker E, Blin O, Tarragon E, Bordet R. Evaluation of symptomatic drug effects in Alzheimer's disease: strategies for prediction of efficacy in humans. DRUG DISCOVERY TODAY. TECHNOLOGIES 2014; 10:e329-42. [PMID: 24179995 DOI: 10.1016/j.ddtec.2013.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In chronic diseases such as Alzheimer's disease (AD), the arsenal of biomarkers available to determine the effectiveness of symptomatic treatment is very limited. Interpretation of the results provided in literature is cumbersome and it becomes difficult to predict their standardization to a larger patient population. Indeed, cognitive assessment alone does not appear to have sufficient predictive value of drug efficacy in early clinical development of AD treatment. In recent years, research has contributed to the emergence of new tools to assess brain activity relying on innovative technologies of imaging and electrophysiology. However, the relevance of the use of these newer markers in treatment response assessment is waiting for validation. This review shows how the early clinical assessment of symptomatic drugs could benefit from the inclusion of suitable pharmacodynamic markers. This review also emphasizes the importance of re-evaluating a step-by-step strategy in drug development.
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Dresler M, Sandberg A, Ohla K, Bublitz C, Trenado C, Mroczko-Wąsowicz A, Kühn S, Repantis D. Non-pharmacological cognitive enhancement. Neuropharmacology 2013; 64:529-43. [DOI: 10.1016/j.neuropharm.2012.07.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 06/30/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
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Dodds CM, Bullmore ET, Henson RN, Christensen S, Miller S, Smith M, Dewit O, Lawrence P, Nathan PJ. Effects of donepezil on cognitive performance after sleep deprivation. Hum Psychopharmacol 2011; 26:578-87. [PMID: 22161694 DOI: 10.1002/hup.1248] [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] [Received: 07/11/2011] [Accepted: 10/19/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify tasks that were sensitive to a temporary decline in cognitive performance after sleep deprivation and to investigate the ability of the acetylcholinesterase inhibitor donepezil to reverse any sleep deprivation-induced impairment. METHODS Thirty healthy volunteers were administered either a 5-mg daily dose of donepezil or placebo for 14-17 days, in a double-blind parallel group design, then underwent either 24 h sleep deprivation or a normal night of sleep in non-blinded crossover, and were subsequently tested on a battery of cognitive tasks designed to measure different components of memory and executive function. RESULTS Sleep deprivation selectively impaired performance on several memory tasks whilst also impairing non-memory function on these tasks. Performance on other tasks was spared. Despite partially reversing the decline in subjective alertness associated with sleep deprivation, treatment with donepezil failed to significantly reverse the decline in cognitive performance on any of the tasks. CONCLUSIONS The results demonstrate the sensitivity of certain tests, particularly those that measure memory function, to cognitive impairment after sleep deprivation. The inability of donepezil to reverse this performance decline suggests that the sleep deprivation model of cognitive impairment may not be suitable for detecting pro-cognitive effects of cholinergic augmentation.
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Affiliation(s)
- Chris M Dodds
- Clinical Unit Cambridge, Medicines Discovery & Development, GlaxoSmithKline R&D, Cambridge, UK.
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Donepezil impairs memory in healthy older subjects: behavioural, EEG and simultaneous EEG/fMRI biomarkers. PLoS One 2011; 6:e24126. [PMID: 21931653 PMCID: PMC3169575 DOI: 10.1371/journal.pone.0024126] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 08/04/2011] [Indexed: 11/21/2022] Open
Abstract
Rising life expectancies coupled with an increasing awareness of age-related cognitive decline have led to the unwarranted use of psychopharmaceuticals, including acetylcholinesterase inhibitors (AChEIs), by significant numbers of healthy older individuals. This trend has developed despite very limited data regarding the effectiveness of such drugs on non-clinical groups and recent work indicates that AChEIs can have negative cognitive effects in healthy populations. For the first time, we use a combination of EEG and simultaneous EEG/fMRI to examine the effects of a commonly prescribed AChEI (donepezil) on cognition in healthy older participants. The short- and long-term impact of donepezil was assessed using two double-blind, placebo-controlled trials. In both cases, we utilised cognitive (paired associates learning (CPAL)) and electrophysiological measures (resting EEG power) that have demonstrated high-sensitivity to age-related cognitive decline. Experiment 1 tested the effects of 5 mg/per day dosage on cognitive and EEG markers at 6-hour, 2-week and 4-week follow-ups. In experiment 2, the same markers were further scrutinised using simultaneous EEG/fMRI after a single 5 mg dose. Experiment 1 found significant negative effects of donepezil on CPAL and resting Alpha and Beta band power. Experiment 2 replicated these results and found additional drug-related increases in the Delta band. EEG/fMRI analyses revealed that these oscillatory differences were associated with activity differences in the left hippocampus (Delta), right frontal-parietal network (Alpha), and default-mode network (Beta). We demonstrate the utility of simple cognitive and EEG measures in evaluating drug responses after acute and chronic donepezil administration. The presentation of previously established markers of age-related cognitive decline indicates that AChEIs can impair cognitive function in healthy older individuals. To our knowledge this is the first study to identify the precise neuroanatomical origins of EEG drug markers using simultaneous EEG/fMRI. The results of this study may be useful for evaluating novel drugs for cognitive enhancement.
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Drug Therapy of Post-Stroke Aphasia: A Review of Current Evidence. Neuropsychol Rev 2011; 21:302-17. [DOI: 10.1007/s11065-011-9177-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/27/2011] [Indexed: 11/26/2022]
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Cholinergic modulation of cognition: insights from human pharmacological functional neuroimaging. Prog Neurobiol 2011; 94:360-88. [PMID: 21708219 PMCID: PMC3382716 DOI: 10.1016/j.pneurobio.2011.06.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 06/02/2011] [Accepted: 06/07/2011] [Indexed: 11/22/2022]
Abstract
Evidence from lesion and cortical-slice studies implicate the neocortical cholinergic system in the modulation of sensory, attentional and memory processing. In this review we consider findings from sixty-three healthy human cholinergic functional neuroimaging studies that probe interactions of cholinergic drugs with brain activation profiles, and relate these to contemporary neurobiological models. Consistent patterns that emerge are: (1) the direction of cholinergic modulation of sensory cortex activations depends upon top-down influences; (2) cholinergic hyperstimulation reduces top-down selective modulation of sensory cortices; (3) cholinergic hyperstimulation interacts with task-specific frontoparietal activations according to one of several patterns, including: suppression of parietal-mediated reorienting; decreasing ‘effort’-associated activations in prefrontal regions; and deactivation of a ‘resting-state network’ in medial cortex, with reciprocal recruitment of dorsolateral frontoparietal regions during performance-challenging conditions; (4) encoding-related activations in both neocortical and hippocampal regions are disrupted by cholinergic blockade, or enhanced with cholinergic stimulation, while the opposite profile is observed during retrieval; (5) many examples exist of an ‘inverted-U shaped’ pattern of cholinergic influences by which the direction of functional neural activation (and performance) depends upon both task (e.g. relative difficulty) and subject (e.g. age) factors. Overall, human cholinergic functional neuroimaging studies both corroborate and extend physiological accounts of cholinergic function arising from other experimental contexts, while providing mechanistic insights into cholinergic-acting drugs and their potential clinical applications.
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Jicha GA, Nelson PT. Management of frontotemporal dementia: targeting symptom management in such a heterogeneous disease requires a wide range of therapeutic options. Neurodegener Dis Manag 2011; 1:141-156. [PMID: 21927623 PMCID: PMC3172080 DOI: 10.2217/nmt.11.9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
There are no US FDA-approved therapies for the management of frontotemporal dementia (FTD). Evidence-based medicine that would support a FDA indication for the treatment of FTD requires large-scale, randomized, double-blind, placebo-controlled trials that do not currently exist. Progress in obtaining approval and therapeutic indications for FTD has been severely hampered by the heterogeneity of clinical and pathological phenotypes seen in various FTD disease states. These issues are often misinterpreted by clinicians, caregivers and patients suggesting that potential treatment options are nonexistent for this devastating disease. This article discusses these issues in the context of recent studies and publications investigating therapeutic options in FTD, and further suggests a rationale for individualized therapy in FTD. Targeting the myriad of symptoms seen in FTD requires recognition of such symptoms that may play primary or secondary roles in the spectrum of deficits that lead to functional disability in FTD, and the availability of a wide range of therapeutic options that may be helpful in alleviating such symptomatology. Fortunately, agents targeting the many cognitive, behavioral, psychiatric and motor symptoms that can be seen in FTD are readily available, having been previously developed and approved for symptomatic benefit in other disease states. In contrast to the widespread belief that beneficial treatments are not available for FTD today, our therapeutic armament is stocked with pharmacological tools that may improve quality of life for those suffering from this devastating and incurable class of degenerative diseases.
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Affiliation(s)
- Gregory A Jicha
- Sanders-Brown Center on Aging, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- University of Kentucky Alzheimer’s Disease Center, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- Department of Neurology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Peter T Nelson
- Sanders-Brown Center on Aging, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- University of Kentucky Alzheimer’s Disease Center, 101 Sanders-Brown Building, University of Kentucky, Lexington, KY 40536-0230, USA
- Department of Neuropathology, University of Kentucky College of Medicine, Lexington, KY, USA
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Husain M, Mehta MA. Cognitive enhancement by drugs in health and disease. Trends Cogn Sci 2011; 15:28-36. [PMID: 21146447 PMCID: PMC3020278 DOI: 10.1016/j.tics.2010.11.002] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 10/19/2010] [Accepted: 11/08/2010] [Indexed: 01/09/2023]
Abstract
Attempts to improve cognitive function in patients with brain disorders have become the focus of intensive research efforts. A recent emerging trend is the use of so-called cognitive enhancers by healthy individuals. Here, we consider some of the effects - positive and negative - that current drugs have in neurological conditions and healthy people. We conclude that, to date, experimental and clinical studies have demonstrated relatively modest overall effects, most probably because of substantial variability in response both across and within individuals. We discuss biological factors that might account for such variability and highlight the need to improve testing methods and to extend our understanding of how drugs modulate specific cognitive processes at the systems or network level.
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Affiliation(s)
- Masud Husain
- UCL Institute of Cognitive Neuroscience and UCL Institute of Neurology, 17 Queen Square, London WC1N 3AR, UK.
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Repantis D, Laisney O, Heuser I. Acetylcholinesterase inhibitors and memantine for neuroenhancement in healthy individuals: a systematic review. Pharmacol Res 2010; 61:473-81. [PMID: 20193764 DOI: 10.1016/j.phrs.2010.02.009] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Revised: 02/21/2010] [Accepted: 02/22/2010] [Indexed: 11/27/2022]
Abstract
The term neuroenhancement refers to improvement in the cognitive, emotional and motivational functions of healthy individuals through, inter alia, the use of drugs. Of known interventions, psychopharmacology provides readily available options, such as the anti-dementia drugs, e.g. acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine. Based on a systematic review we found that expectations about the potential of these drugs exceed their actual effects, as has been demonstrated in randomised controlled trials. Both single and repeated dose trials were included in the systematic review, however repeated dose trials have only been conducted for donepezil. In six small trials lasting 14-42 days, the following results emerged: donepezil improved the retention of training on complex aviation tasks and verbal memory for semantically processed words. In one study episodic memory was improved, whereas in others it remained unaffected by donepezil. In a sleep deprivation trial, donepezil reduced the memory and attention deficits resulting from 24h of sleep deprivation. Two studies reported even transient negative effects. Regarding the safety profile of donepezil, these studies found that it was rather well tolerated. In any case, since large longitudinal studies are not available no conclusions can be drawn. Seven small studies about the effects of a single dose of memantine, and one study with a single dose of rivastigmine have been reported. Again, these studies are not adequate to answer our research question. If, as here and elsewhere suggested, the concept of pharmaceutical neuroenhancement is not to be rejected in principle, the decision of healthy individuals to take drugs for the purpose of neuroenhancement should be based on exhaustive information. At the moment, the research that would support or oppose the use of acetylcholinesterase inhibitors and memantine for neuroenhancement by healthy individuals has not yet been performed.
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Affiliation(s)
- Dimitris Repantis
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany.
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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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Bentley P, Driver J, Dolan R. Modulation of fusiform cortex activity by cholinesterase inhibition predicts effects on subsequent memory. Brain 2009; 132:2356-71. [DOI: 10.1093/brain/awp176] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pietrzak RH, Maruff P, Snyder PJ. Methodological improvements in quantifying cognitive change in clinical trials: an example with single-dose administration of donepezil. J Nutr Health Aging 2009; 13:268-73. [PMID: 19262966 DOI: 10.1007/s12603-009-0071-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Change in cognitive function in response to a pharmacologic challenge can be observed with greater sensitivity by employing cognitive tests with optimal psychometric properties and a statistical approach that more accurately accounts for individual variability in performance. To demonstrate this approach we examined the cognitive effects of a single acute dose administration of an acetylcholinesterase inhibitor, donepezil, in healthy older adults and in older adults with mild Alzheimer's disease (AD). DESIGN Placebo-controlled crossover study with three separate testing days: baseline, placebo, and donepezil, with assessments at baseline, and 1-, 2-, 3-, 6-, and 8-hrs post-dosing on each day. SETTING Early phase I clinical trial. PARTICIPANTS 15 healthy older adults; 14 older adults with mild Alzheimer's disease. INTERVENTION Single acute dose of 5mg donepezil. MEASUREMENTS Performance on the Groton Maze Learning Test (GMLT), a computerized neuropsychological measure of spatial working memory and error monitoring. RESULTS A single acute dose of donepezil improved GMLT performance in healthy older adults (effect size: 0.83 at 6 hrs post-dosing) and older adults with mild AD (effect size: 0.58 at 3 hrs post-dosing). CONCLUSION The GMLT detected cognitive improvement following a single, acute dose administration of donepezil in healthy older adults and older adults with mild AD. The choice of cognitive tests designed for repeated administration, as well as an analytic approach that emphasizes individual-level change in cognitive function, provides a sensitive approach to detecting central nervous system drug penetration and activity of cognitive-enhancing agents.
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Affiliation(s)
- R H Pietrzak
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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