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Malik N, Amber S, Zahid S. Rosmarinus officinalis and Methylphenidate Exposure Improves Cognition and Depression and Regulates Anxiety-Like Behavior in AlCl3-Induced Mouse Model of Alzheimer’s Disease. Front Pharmacol 2022; 13:943163. [PMID: 36034857 PMCID: PMC9411514 DOI: 10.3389/fphar.2022.943163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/20/2022] [Indexed: 11/22/2022] Open
Abstract
Alzheimer’s disease (AD) is a neurological illness that causes severe cognitive impairment. AD patients also experience at least one of the neuropsychiatric symptoms including apathy, depression, and anxiety during the course of their life. Acetylcholine esterase inhibitors are the available treatment options to alleviate cognitive deficits, whereas methylphenidate (MPH), a psychostimulant, is considered for the treatment of apathy in AD patients. Rosmarinus officinalis, a perennial herb, has been potentially known to have antioxidant and anti-inflammatory properties. The present study investigated the potential effects of MPH and R. officinalis in comparison with the standard drug, Donepezil, on cognition, anxiety, and depression in the AlCl3-induced mouse model of AD. The animals were divided into eight groups (n = 8, each). The results revealed that the MPH- and R. officinalis-treated groups significantly improved memory impairment, whereas R. officinalis substantially reduced depression and anxiety as compared with other treatment groups. MPH treatment induced an antidepressant effect and increased anxiety-like behavior. Moreover, the AlCl3 exposure led to the formation of amyloid beta (Aβ) plaques in mice hippocampus; however, none of the tested drugs caused a significant reduction in amyloid burden at the selected doses. The present study suggested the potential of R. officinalis to improve memory as well as neuropsychiatric symptoms in AD. Although R. officinalis improved cognitive abilities, it did not reduce the amyloid plaque burden, which indicates that the memory-enhancing effects of R. officinalis are due to some alternate mechanism that needs to be explored further.
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Rosenau PT, Openneer TJC, Matthijssen AM, van de Loo‐Neus GHH, Buitelaar JK, van den Hoofdakker BJ, Hoekstra PJ, Dietrich A. Effects of methylphenidate on executive functioning in children and adolescents with ADHD after long-term use: a randomized, placebo-controlled discontinuation study. J Child Psychol Psychiatry 2021; 62:1444-1452. [PMID: 33778945 PMCID: PMC9292145 DOI: 10.1111/jcpp.13419] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Methylphenidate may improve executive functioning in children with attention-deficit/hyperactivity disorder (ADHD). However, it is unclear if there are still acute effects of methylphenidate on executive functioning after long-term use. METHODS In a randomized double-blind, placebo-controlled discontinuation study, 94 children and adolescents (ages 8-18 years) who used methylphenidate beyond two years were either assigned to seven weeks of continued treatment with 36 or 54 mg of extended-release methylphenidate or to gradual withdrawal over three weeks to placebo for four weeks. Performance on neuropsychological tasks, measuring working memory, response inhibition, attentional flexibility and psychomotor speed was compared between both groups using mixed models for repeated measures. Additionally, we investigated within the discontinuation group if a deterioration on the investigator-rated Clinical Global Impressions Improvement scale after withdrawing to placebo was related to a worse performance on the neuropsychological tasks. This study was registered in the Netherlands Trial Register (www. Trialregister.nl) with identifier 5252. RESULTS After withdrawal of methylphenidate, the discontinuation group made more errors on working memory (β = -1.62, SD = 0.56, t = -2.88, p = .01, Cohen's f2 = .14), independent from reaction time compared to baseline, in contrast to the continuation group. We did not find differences in changes in response inhibition, attentional flexibility and psychomotor speed between the two groups. Also, there were no significant differences in task measures between the participants who deteriorated clinically and those who did not. CONCLUSIONS Our study shows that methylphenidate has a beneficial effect on working memory after two years of use. Future studies should explore whether cognitive outcomes may aid clinical decision-making on the continued use of methylphenidate, given dissociation between cognitive and behavioural effects of stimulant medication.
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Affiliation(s)
- Paul T. Rosenau
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Thaïra J. C. Openneer
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Anne‐Flore M. Matthijssen
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | | | - Jan K. Buitelaar
- Karakter Child and Adolescent Psychiatry Center NijmegenNijmegenThe Netherlands,Cognitive Neuroscience, Donders Institute for Brain, Cognition and BehaviourRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
| | - Barbara J. van den Hoofdakker
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Pieter J. Hoekstra
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Andrea Dietrich
- Department of Child and Adolescent PsychiatryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Göl Özcan G, Öztürk Y, Sari M, İmrek Y, Özyurt G, Tufan AE, Akay AP. Drug holidays may not affect processing speed while they may reduce beneficial effects on resistance to interference among children with treated with methylphenidate: a single-center, prospective study. Nord J Psychiatry 2021; 75:323-329. [PMID: 33356759 DOI: 10.1080/08039488.2020.1855242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of drug holidays during summer vacations among children with attention deficit/hyperactivity disorder (ADHD) who were treated with methylphenidate in terms of ADHD symptoms and executive functions. METHODS The study was a prospective cohort study that includes pre-treatment, post-treatment and post-drug holiday evaluations. ADHD symptom severity was evaluated with the Clinical Global Impression Scale (CGI), the Conners' Parental Rating Scale-Short Form (CPRS) and the Conners' Teacher Rating Scale- Short Form (CTRS). The Stroop Color Word Test- TBAG Form (SCWT) was used to evaluate executive functions. Fifty-one patients participated in the study according to the inclusion and exclusion criteria. Methylphenidate (MPH) was started at 0.5 mg/kg/day and titrated weekly to a maximum of 1.2 mg/kg/day. During the follow-up period, 22 (43.0%) of the patients stopped treatment. RESULTS Completion times for all SCWT subtests were significantly reduced after treatment (p < 0.001, p = 0.002, p < 0.001, p = 0.002, p < 0.001; respectively). Mean number of corrections in SCWT-3 and mean number of errors as well as corrections in SCWT-5 significantly reduced after treatment (p = 0.047, p = 0.005, p = 0.007; respectively). Mean number of corrections in SCWT-3 and mean number of errors in SCWT-5 increased significantly after drug holiday compared to post-treatment (p = 0.032 and p = 0.037; respectively). CONCLUSION Our results suggest that psychomotor speed and resistance to interference improved in children with ADHD receiving methylphenidate treatment. Drug holidays did not affect psychomotor speed while beneficial effects on resistance to interference were reduced with drug holidays.
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Affiliation(s)
- Güler Göl Özcan
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Yusuf Öztürk
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Mesut Sari
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Yasemin İmrek
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Gonca Özyurt
- Department of Child and Adolescent Psychiatry, Izmir Katip Çelebi University Medical Faculty, Izmir, Turkey
| | - Ali Evren Tufan
- Department of Child and Adolescent Psychiatry, Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Aynur Pekcanlar Akay
- Department of Child and Adolescent Psychiatry, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Abstract
Nootropics are drugs used to either treat or benefit cognition deficits. Among this class, methylphenidate is a popular agent, which acts through indirect dopaminergic and noradrenergic agonism and, therefore, is proposed to enhance performance in catecholamine-dependent cognitive domains such as attention, memory and prefrontal cortex-dependent executive functions. However, investigation into the efficacy of methylphenidate as a cognitive enhancer has yielded variable results across all domains, leading to debate within the scientific community surrounding its off-label use in healthy individuals seeking scholaristic benefit or increased productivity. Through analysis of experimental data and methodological evaluation, it is apparent that there are dose-, task- and domain-dependent considerations surrounding the use of methylphenidate in healthy individuals, whereby tailored dose administration is likely to provide benefit on an individual basis dependent on the domain of cognition in which benefit is required. Additionally, it is apparent that there are subjective effects of methylphenidate, which may increase user productivity irrespective of cognitive benefit. Whilst there is not extensive study in healthy older adults, it is plausible that there are dose-dependent benefits to methylphenidate in older adults in selective cognitive domains that might improve quality of life and reduce fall risk. Methylphenidate appears to produce dose-dependent benefits to individuals with attention-deficit/hyperactivity disorder, but the evidence for benefit in Parkinson's disease and schizophrenia is inconclusive. As with any off-label use of pharmacological agents, and especially regarding drugs with neuromodulatory effects, there are inherent safety concerns; epidemiological and experimental evidence suggests there are sympathomimetic, cardiovascular and addictive considerations, which might further restrict their use within certain demographics.
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Low AM, le Sommer J, Vangkilde S, Fagerlund B, Glenthøj B, Sonuga-Barke E, Habekost T, Jepsen JRM. Delay Aversion and Executive Functioning in Adults With Attention-Deficit/Hyperactivity Disorder: Before and After Stimulant Treatment. Int J Neuropsychopharmacol 2018; 21:997-1006. [PMID: 30124878 PMCID: PMC6209856 DOI: 10.1093/ijnp/pyy070] [Citation(s) in RCA: 8] [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: 04/03/2018] [Accepted: 08/14/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder is a heterogeneous disorder, associated with deficits in motivation (e.g., delay aversion) and cognition. Methylphenidate is recommended as a first line treatment for attention deficit hyperactivity disorder symptoms, but little is known about its nonacute effects on motivational and cognitive deficits, particularly in adults with attention deficit hyperactivity disorder. METHODS We utilized a prospective, non-randomized, non-blinded, 6-week follow-up design with 42 initially stimulant medication-naïve adult patients with moderate to severe attention deficit hyperactivity disorder, and 42 age- and parental education-matched healthy controls. Delay aversion and executive functioning were assessed with 2 questionnaires and 5 performance-based tests. RESULTS At baseline, patients and controls differed significantly on performance-based measures (moderate to large effect sizes), and self-report of delay aversion and executive functioning (very large effect sizes). Treatment with methylphenidate medication (mean dose 65.54 mg/d, SD=10.39) was not associated with improvements in performance-based measures of delay aversion and executive functioning compared to controls, although improvements in self-report executive functioning and delay aversion were found. Self-reported delay aversion was most consistently associated with ADHD symptomatology at baseline and after medication. CONCLUSION Methylphenidate treatment does not have an effect on performance-based measures of delay aversion and executive functioning, but may have significant effects on self-reported delay aversion and executive functioning. The latter finding should be interpreted cautiously, given the subjective nature of these measures and design limitations. Self-reported delay aversion is most consistently associated with attention deficit hyperactivity disorder symptomatology.
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Affiliation(s)
- Ann-Marie Low
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark,Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Correspondence: Ann-Marie Low, Department of Psychology, University of Copenhagen, Østre Farimagsgade 2A, 1353 Copenhagen K, Denmark ()
| | - Julijana le Sommer
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Signe Vangkilde
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Fagerlund
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark,Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College, London, United Kingdom
| | - Thomas Habekost
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jens Richardt Møllegaard Jepsen
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Child and Adolescent Mental Health Center, Mental Health Services, Copenhagen, Denmark
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