Nootropic Drugs in the Treatment of Alzheimer’s Disease: Cerebrolysin-Part XV
As we reported in the first of this series on Alzheimer’s disease, nootropic drugs exert a regulatory effect on neuronal metabolism, and influence synaptic plasticity and learning behavior. Some research investigators saw a use of this class of drugs in treating Alzheimer’s disease. The difficulty in using these drugs was how to deliver them so that they would pass through the blood-brain barrier, a membranous barrier that segregates the brain interstitial fluid surrounding the synapses from the circulating blood. Once in the fluid, they could exert an effect on the synapses. This difficulty has been solved and now the race is on to develop a drug that could prove effective in treating Alzheimer’s disease and possibly have some protective effect to shield against Alzheimer’s disease.
Cerebrolysin is a nootropic drug that has been shown to have a neurotrophic effect inside the brain through its biologically active peptides. Ruther and his group, reporting in the journal Pharmacopsychiatry in 1994 on the "Efficacy of the peptidergic nootropic drug Cerebrolysin" in patients with senile dementia of the Alzheimer’s disease type" suggested that a sustained improvement in the treatment group was recorded 6 months after the start of drug therapy". This implies that the progression of the disease was slowed in the Cerebrolysin group.
This month, a group of Korean investigators, reporting in the Journal of the American Geriatric Society (JAGS) suggested that "the peripheral application of Cerebrolysin protected cholinergic cells in the medial system from degeneration" after only 4 weeks of therapy. The subjects used in this research were 35 women and 18 men, with 34 of these individuals in the treatment group and 19 in a placebo group. The study used a randomized, multicentered, double blind, placebo-controlled protocol. Participants in the study had mild to moderate Alzheimer’s disease. They were treated in an inpatient setting with 3 ampoules (30 mL of Cerebrolysin) in 100mL physiological saline IV. The infusions were given for more than 30 minutes once a day from Monday to Friday for 4 weeks. They report no adverse effects from the drug treatment as opposed to some of the other medications on the market today.
The sample studied in this research was small and involved an intravenous inpatient treatment protocol. This treatment was geared toward alleviating the progressive symptoms, and is not a cure for Alzheimer’s disease. There is no report on the individual cost-effectiveness of this medication protocol. A study like this will have to be repeated with a larger pool of individuals and will have to look at the results at 6months and one year when compared to a placebo group to determine its effectiveness. We would also note a word of caution in using an IV treatment: it increases the potential for infection.
It seems now that almost every month brings another report of some medication that promises to repair damaged brains. Tantalizing reports give us hope. The above information on Cerebrolysin is one of those reports that people should know about, but understand it a palliative treatment. The more exciting news is the work being done on stem cells that could mean easily accessible cells from bone marrow might someday be used to treat a wide range of neurological diseases. Future articles in this series will contain information about research in this area.
Ruther E., Ritter R., Apecechea M. et al. Efficacy of the peptidergic nootropic drug Cerebrolysin in patients with senile dementia of the Alzheimer’s disease type. Pharmacopsychiatry 1994; 27: 32-40
Bae CH, Cho CY, Cho K, Oh BH et al. A Double Blind, Placebo-Controlled, Multicentered Study of Cerebrolysin for Alzheimer’s Disease. JAGS 2001: 48:1566-1571.
See: Alzheimer's Disease Part I-Medications for Alzheimer's.
See: Alzheimer’s Disease Part II- Selegiline and AD.
See: Alzheimer's Disease Part III- Use of Gingko Biloba in memory problems of Alzheimer patients.
See: Alzheimer's Disease PartIV-Alternative Treatment.
See: Alzheimer's Disease Part V-Possible New Drugs for Alzheimer's Disease Treatment.
See: Alzheimer's Part VI -Early Diagnosis.
See: Alzheimer's Part VII -New Medication-Metrifonate
See: Alzheimer's Part VIII-Implications of Longer Life Expectancies
See: Alzheimer's Part IX-Ethical Care Principles
See: Alzheimer's Disease Part X-Estrogen and Alzheimer's Disease
See: Alzheimer's Disease Part XI-Pocket Smell Test
See: Alzheimer's Disease Part XII-MAO-B
See: Alzheimer's Disease Part XIII-Critical Flicker Fusion Threshold Test
See: Alzheimer's Disease Part XIV-Donepezil
See: Alzheimer's Disease Part XVI-MCI
See: Alzheimer's Disease Part XVII-Summary
See: Alzheimer's Disease Part XVIII-NO Releasing NSAIDs
See: Alzheimer's Disease Part XIX-Vitamin E
See: Alzheimer's Disease-Part XX-Clinical Trials
See: Alzheimer's Disease Part XXI-The Brain
See Dementia with Lewy Bodies- Part XXII-by Gourete Broderick
See: Alzheimer's Disease-Part XXIII-HMG
See: Alzheimer's Disease-Part XXIV-A Prequel
See: Alzheimer's Disease-Part XXV-Psychosis
See: Alzheimer's Disease-Part XXVI-Amyloid-beta Hypothesis Controversy
See: Alzheimer's Disease-Part XXVII- AD and Diabetes
See: Alzhemeir's Disease-Part XXVIII - Insulin and AD
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME"
Harold Rubin, MS, ABD, CRC, Guest Lecturer
December 28, 2000
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