Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases? Effect of Piracetam on Recovery and Rehabilitation After Stroke: A Double‐Blind, Placebo‐Controlled Study Restitution of alpha-topography by piracetam in post-stroke aphasia. Piracetam Improves Activated Blood Flow and Facilitates Rehabilitation of Poststroke Aphasic Patients Piracetam as an adjuvant to language therapy for aphasia: a randomized double-blind placebo-controlled pilot study. Interaction between psychological and pharmacological treatment in cognitive impairment. [Cognitive enhancement effect of piracetam in patients with mild cognitive impairment and dementia]. Long-Term Antidepressant Treatment with Moclobemide for Aphasia in Acute Stroke Patients: A Randomised, Double-Blind, Placebo-Controlled Study Piracetam combined with lecithin in the treatment of Alzheimer's disease Piracetam improves children's memory after general anaesthesia. A Double-Blind, Placebo-Controlled Study of the Use of Amphetamine in the Treatment of Aphasia [The effect of piracetam on involuntary movements in Huntington's disease. A double-blind, placebo-controlled study]. Long‐term and high‐dose piracetam treatment of Alzheimer's disease A controlled trial of piracetam in intellectually impaired patients with Parkinson's disease. Aphasia, Depression, and Non-Verbal Cognitive Impairment in Ischaemic Stroke Dual-Hemisphere Repetitive Transcranial Magnetic Stimulation for Rehabilitation of Poststroke Aphasia Piracetam prevents cognitive decline in coronary artery bypass: a randomized trial versus placebo.
Aphasia causes significant disability and h and icap among stroke survivors . Language therapy is recommended for aphasic patients , but not always available . Piracetam , an old drug with novel properties , has been shown to have mild beneficial effects on post-stroke aphasia . In the current study , we investigated the effects of 6 months treatment with piracetam on aphasia following stroke . Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study . The scores for the National Institutes of Health Stroke Scale ( NIHSS ) , Barthel Index ( BI ) , modified Rankin Scale ( mRS ) , and Gülhane Aphasia Test were recorded . The patients were scheduled r and omly to receive either 4.8 g piracetam daily or placebo treatment for 6 months . At the end of 24 weeks , clinical assessment s and aphasia tests were repeated . The level of improvement in the clinical parameters and aphasia scores was compared between the two groups . All patients had large lesions and severe aphasia . No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS , BI and mRS scores at the end of the treatment . The improvements observed in spontaneous speech , reading fluency , auditory comprehension , reading comprehension , repetition , and naming were not significantly different in the piracetam and placebo groups , the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment . Piracetam is well-tolerated in patients with post-stroke aphasia .  Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders Summary : The nootropic agent piracetam has been shown to improve learning and memory , and it may , by this means , facilitate recovery and rehabilitation after a stroke . We report the results of a pilot study exploring its effects in patients undergoing rehabilitation after acute cerebral infa rct ion in the carotid artery territory . We compared piracetam and placebo , each given for 12 weeks , in a multicenter , double-blind , r and omized trial of parallel-group design ; testing was performed at baseline ( 6–9 weeks poststroke ) , weeks 5 and 12 , and , in fewer patients , 12 weeks after termination of treatment . St and ardized tests of activities of daily living ( Barthel Index , Kuriansky Test ) , aphasia ( Aachen Aphasia Test ) , and perception ( Rivermead Perception Assessment Battery ) were the primary efficacy variables . Of 158 patients , 137 ( 81 males , 56 females ) were studied after treatment and 88 at 24-week follow-up . Thirty patients on piracetam ( 45 % ) and 37 on placebo ( 53 % ) were aphasic on entry . Both groups , including the subgroups with aphasia , were well matched at baseline for demographic data , stroke sequelae , type and severity of aphasia , and prognostic parameters . Multivariate analysis of Aachen Aphasia subtest scores showed a significant overall improvement relative to baseline in favor of piracetam ( p = 0.02 ) at 12 weeks . This was not seen at 24 weeks when , however , fewer patients were available for evaluation so that we could neither confirm nor deny whether improvement was maintained after cessation of piracetam . We were unable to demonstrate an effect on tests of activities of daily living and could neither confirm nor exclude an effect on perceptual deficit . We have shown an improvement in aphasia in patients undergoing rehabilitation after a stroke after 12 weeks ' treatment with piracetam that requires confirmation in further studies OBJECTIVE Electroencephalographic and clinical effects of piracetam in post-stroke aphasia were evaluated in a prospect i ve , r and omized , double-blind , placebo-controlled trial . METHODS In 24 patients with mild to moderate aphasia after ischemic stroke , quantitative topographic EEG at rest was studied before and after a 6-week treatment period . RESULTS In the active treatment group , a significant shift in the alpha-rhythm from frontal to occipital regions was observed which may be due to a restitution of corticothalamic circuits involved in the generation of alpha-activity . CONCLUSION Neuropsychological scores improved significantly and markedly in various domains of speech during piracetam treatment , whereas improvements were less marked and restricted to a few categories in the placebo group Background and Purpose In a prospect i ve , double-blind , placebo-controlled study , it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow . Methods Twenty-four stroke patients with aphasia were r and omly allocated to 2 groups : 12 patients received  2400 mg piracetam twice daily , 12 placebo . Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy , the patients were examined neuropsychologically and studied with H215O PET at rest and during activation with a word-repetition task .  Blood flow was analyzed in 14 language -activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images . Results Before treatment , both groups were comparable with respect to performance in language tasks and to type and severity of aphasia . In the piracetam group , increase of activation effect was significantly higher ( P < 0.05 ) in the left transverse temporal gyrus , left triangular part of inferior frontal gyrus , and left posterior superior temporal gyrus after the treatment period compared with the initial measures . The placebo group showed an increase of activation effect only in the left vocalization area . In the test battery , the piracetam group improved in 6 language functions , the placebo group only in 3 subtests . Conclusions Piracetam as an adjuvant to speech therapy improves recovery of various language functions , and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere OBJECTIVE To determine whether piracetam 4.8 g/day together with intensive language therapy improved language function more than language therapy alone . DESIGN Double-blind , placebo-controlled parallel group study . SETTING Referral speech and language clinic of a university department of neurology . PATIENTS Sixty-six in patients with aphasia present between 4 weeks and 36 months . INTERVENTIONS Intensive language therapy for 6 weeks in all patients . Thirty-two patients received piracetam 4.8 g daily and 34 patients received placebo . MAIN OUTCOME MEASURE The Aachen Aphasia Test ( AAT ) , a st and ardized procedure for evaluating the severity of aphasia , was performed at baseline and after 6 weeks ' treatment . RESULTS In 50 patients evaluated for efficacy , a trend toward improvement in the active group was observed in all subtests of the AAT . This trend was statistically significant for absolute differences in recovery of " written language " and " profile level . " CONCLUSION Piracetam appears to have a positive adjuvant effect on the recovery of aphasia in patients receiving intensive language therapy In contrast to other kinds of psychotropic drugs , nootropics or cognition enhancing drugs may be indicated , not for the direct treatment of the pathology itself , but for improving or restoring the remaining brain functions . Brain functions are normally trained during various kinds of non-medical therapy , such as physiotherapy , speech therapy , occupational therapy , memory training etc ... In research little attention has been paid to the combination of both kinds of therapeutic approaches , probably because of the important method ological difficulties . This combination however , offers various interesting perspectives : L. ISRAEL examined in two placebo-controlled studies the effects of either 160 mg/d of ginkgo biloba extractum ( GBE ) or piracetam 2.4 or 4.8 g/d , combined with a memory training program , in nondemented patients complaining of memory problems . The results of both studies suggest that nootropic drug treatment and memory training have each an effect on different cognitive functions and , hence , are complementary . Some functions , like attention/perception in the GBE study and learning in the piracetam study , seem to benefit from both treatments , suggesting a mutually potentiating effect of drug treatment and training . This potentiation is very clear in the treatment of dyslexic children : in a placebo-controlled study piracetam 3.3 g/d , in combination with normal school teaching and more specific logopedic therapy , allowed a normal progression during the full school year in reading accuracy and reading comprehension , while the placebo treated children getting a similar training progressed only with 50 % . Recently promising results were obtained in the treatment of dysphasic patients with a combination of speech therapy and piracetam 4.8 g/d , especially when given during the first months after the stroke , or otherwise in combination with an intensive speech training . In both double-blind studies the piracetam treated group improved about 60 % more than the group who only got speech therapy and placebo . All these data may be explained by the restorative or enhancing influence of nootropic drugs on neurotransmitter systems closely related to learning and memory functions . E.g. piracetam restores the availability and function of muscarinic and NMDA receptors in aging animals , most probably through a modulation of the psychico-chemical properties of the neuronal membrane such as the membrane fluidity Effectiveness and tolerability of two piracetam-containing drugs were compared in the frame of an open , multicentre , Phase-IV , prospect i ve study with group and self control carried out in 9 Hungarian centres in 1998 . Patients with cognitive decline from Alzheimer 's disease and /or cerebrovascular origin have received the drug , in the first 4 weeks in 4800 , later 2400 mg daily doses . One hundred four patients finished the study . No relevant difference with statistically significant degree was registered between the two groups . Based on this fact in this study data of the 104 patients were examined together . Authors examined two problems . The first : on which cognitive function is more effective the drug . Five factors of the modified Mini-Mental State Examination were separated and compared . Nearly all of them significantly increased especially the factors of memory , and concentration-psychomotor speed . The second examined field : are there certain subgroups with prognostic value about the effectiveness of piracetam treatment . Neither the duration of the illness , nor etiologic diagnosis , severity of cognitive decline , or former treatment with piracetam did influence significantly the efficacy . In case of depressive symptoms such connection was established : the more pronounced the severity of these symptoms the higher improvement can be expected in cognitive functions . This was also stressed by the logistic regression analysis . Authors described an original evaluation method of the trail-making test , which could widen the application of this popular test in psychopharmacologic studies . Final conclusions : the cognitive enhancer effect of piracetam appeared in a few weeks . This treatment could be effective even in Alzheimer 's disease , in case of more pronounced cognitive decline , longer duration of the illness , and in case of former piracetam treatment as well . The degree of cognitive improvement was most pronounced in patients with comorbid depressive symptoms Background and Purpose : Pharmacotherapy aim ed at stroke rehabilitation through direct central nervous effects may be assumed to work in a similar way for language recovery and sensory-motor recovery . Some data suggest that antidepressant drugs could be beneficial also for functional improvement . This prompted us to investigate whether regression from aphasia after acute stroke could be enhanced by antidepressive drug therapy . Methods : We r and omised 90 acute stroke patients with aphasia to either 600 mg moclobemide or placebo daily for 6 months , within 3 weeks of the onset of stroke . Aphasia was assessed prior to treatment and at 6 months , using Reinvang ’s ‘ Grunntest for afasi ’ and the Amsterdam-Nijmegen-Everyday- Language -Test ( ANELT ) . Result : The degree of aphasia decreased significantly at 6 months , with no difference between the moclobemide- and the placebo-treated groups . Multivariate regression analysis including treatment group , activities of daily living , aetiology of stroke , ANELT , and Reinvang ’s coefficient at baseline , and neurological deficit confirmed these results . In all , 13 in the moclobemide and 10 in the placebo group stopped taking the study medication . No further change was found in the 56 aphasic patients followed up for another 6 months with no medication . Conclusions : Compared to placebo , treatment with moclobemide for 6 months did not enhance the regression of aphasia following an acute stroke Nootropics , a new class of drugs believed to activate mental functions , have been proposed as a treatment for clinical disorders in which cognition is impaired . We therefore administered the nootropic drug piracetam , alone and in combination with phosphatidylcholine ( PC ) , to 18 patients with Alzheimer 's disease ( AD ) , and measured the effects of treatment on a broad range of cognitive functions .  Piracetam was administered according to three double-blind crossover protocol s and a replication study that differed in piracetam dose ( 2.4 to 9.9 g/day ) and whether PC ( 18 g/day ) was administered concurrently . The drug was well tolerated , and there were not toxic side effects . Plasma choline levels rose significantly during piracetam and PC administration ; monoamine metabolites in cerebrospinal fluid were unaffected by treatment . Piracetam , either alone or in combination with PC , did not significantly affect cognition in the AD group as a whole , nor did it improve test performance in any single patient BACKGROUND Surgery and anaesthesia may account for postoperative complications including cognitive impairment . The purpose of the study was to assess the influence of general anaesthetics on children 's memory and effectiveness of piracetam for prevention of postoperative cognitive dysfunction . METHODS The study included patients receiving different kinds of anaesthesia for various surgical procedures , r and omly allocated to two groups . According to immediate postoperative treatment , the study group received intravenous piracetam 30 mg kg(-1 ) and the control group -- placebo . The cognitive functions were examined preoperatively and within 10 consecutive postoperative days using the ten-word memory test . RESULTS The study group consisted of 123 children , the control one -- of 127 . Declines in memory indexes were observed in all anaesthetized patients . The most injured function was long-term memory . The intravenous administration of piracetam improved this cognitive function . CONCLUSIONS The study results confirm that general anaesthesia affects the memory function in children .  Piracetam is effective for prevention of postoperative cognitive dysfunction after anaesthesia Background and Purpose — A number of studies suggest that drugs which increase the release of norepinephrine promote recovery when administered late ( days to weeks ) after brain injury in animals . A small number of clinical studies have investigated the effects of the noradrenergic agonist dextroamphetamine in patients recovering from motor deficits following stroke . To determine whether these findings extend to communication deficits subsequent to stroke , we administered dextroamphetamine , paired with speech/ language therapy , to patients with aphasia . Methods — In a prospect i ve , double-blind study , 21 aphasic patients with an acute nonhemorrhagic infa rct ion were r and omly assigned to receive either 10 mg dextroamphetamine or a placebo .  Patients were entered between days 16 and 45 after onset and were treated on a 3-day/4-day schedule for 10 sessions . Thirty minutes after drug/placebo administration , subjects received a 1-hour session of speech/ language therapy . The Porch Index of Communicative Ability was used at baseline , at 1 week off the drug , and at 6 months after onset as the dependent language measure . Results — Although there were no differences between the drug and placebo groups before treatment ( P = 0.807 ) , by 1 week after the 10 drug treatments ended there was a significant difference in gain scores between the groups ( P = 0.0153 ) , with the greater gain in the dextroamphetamine group . The difference was still significant when corrected for initial aphasia severity and age . At the 6-month follow-up , the difference in gain scores between the groups had increased ; however , the difference was not significant ( P = 0.0482 ) after correction for multiple comparisons . Conclusions — Administration of dextroamphetamine paired with 10 1-hour sessions of speech/ language therapy facilitated recovery from aphasia in a small group of patients in the subacute period after stroke . Neuromodulation with dextroamphetamine , and perhaps other drugs that increase central nervous system noradrenaline levels , may facilitate recovery when paired with focused behavioral treatment Piracetam and its derivatives , a group of " nootropic " drugs thought to act as metabolic enhancers in the brain , have been widely used to treat a variety of cognitive disorders . Two studies have reported that this compound reduces the severity of involuntary movements in acute onset hemichorea . We therefore r and omly assigned 11 patients with Huntington 's disease to receive high doses of intravenous piracetam ( 12 g in 250 ml of saline ) or placebo on different days . A blinded observer then rated the severity of involuntary movements over a period of 4 hours . Significant aggravation ( p < 0.05 ) of chorea was seen in patients taking piracetam , in comparison with ratings for both baseline and placebo , 4 hours after administration but not during earlier assessment s. Although the mechanism causing this effect is unidentified , we believe that our findings indicate that piracetam should not be used to treat the cognitive disorders accompanying Huntington 's disease Pre clinical research suggests that piracetam ( a nootropic drug ) may improve cognitive functions , but previous studies have failed to demonstrate a clear benefit for the treatment of Alzheimer 's disease ( AD ) . We report a 1-year , double-blind , placebo-controlled , parallel-group study with a high dose of piracetam ( 8 g/d per os ) in 33 ambulant patients with early probable AD . Thirty subjects completed the 1-year study . No improvement occurred in either group , but our results support the hypothesis that long-term administration of high doses of piracetam might slow the progression of cognitive deterioration in patients with AD . The most significant differences concerned the recall of pictures series and recent incident and remote memory . The drug was well-tolerated Twenty patients with Parkinson 's disease and marked intellectual impairment or dementia participated in a double-blind placebo controlled trial of the nootropic , piracetam . A st and ardized neurological examination , a neuropsychological test battery , and a functional scale , The Sickness Impact Profile , were completed for all patients . They were then assigned by blind r and omization to drug or placebo conditions receiving 3.2 g of piracetam or an identical amount of placebo for 12 weeks . The dose was increased to 4.8 g for an additional 12 weeks . Neurological , psychological , and functional measures were rated as improved , unchanged , or worsened in comparison to baseline performance . Twenty-five percent of the patients did not complete the trial for reasons unrelated to the medication . Although there was a significant improvement on one subtest of the functional scale , no significant effects were demonstrated in cognitive or neurological measures Aphasia , depression , and cognitive dysfunction are common consequences of stroke , but knowledge of their interrelationship is limited . This 1-year prospect i ve study was design ed to evaluate prevalence and course of post-stroke aphasia and to study its psychiatric , neurological , and cognitive correlates . We studied a series of 106 consecutive patients ( 46 women and 60 men , mean age 65.8 years ) with first-ever ischaemic brain infa rct ion . The patients were clinical ly examined , and presence and type of aphasia were evaluated during the 1st week after stroke and 3 and 12 months later . Psychiatric and neuropsychological evaluations were performed 3 and 12 months after stroke . Aphasia was diagnosed in 34 % of the patients during the acute phase , and two thirds of them remained so 12 months later . Seventy percent of the aphasic patients fulfilled the DSM-III-R criteria of depression 3 months and 62 % 12 months after stroke . The prevalence of major depression increased from 11 to 33 % during the 12-month follow-up period . The non-verbal neuropsychological test performance in the aphasic patients was significantly inferior to that of the patients with dominant hemisphere lesion without aphasia . One third of the patients with ischaemic stroke suffer from communicative disorders which seem to increase the risk of depression and non-verbal cognitive deficits . Although the prevalence of depression in aphasic patients decreases in the long term , the proportion of patients suffering from major depression seems to increase . We emphasize the importance of the multidimensional evaluation of aphasic stroke patients Background . Recent neuroimaging studies on poststroke aphasia revealed maladaptive cortical changes in both hemispheres , yet their functional contribution in language recovery remains elusive . The aim of this study was to evaluate the long-term efficacy of dual-hemisphere repetitive transcranial magnetic stimulation ( rTMS ) on poststroke aphasia . Methods . Thirty patients with subacute poststroke nonfluent aphasia were r and omly allocated to receive real or sham rTMS . Each patient received 1000 rTMS pulses ( 1 Hz at 110 % of resting motor threshold [ rMT ] over the right unaffected Broca ’s area and 1000 pulses ( 20 Hz at 80 % rMT ) over the left affected Broca ’s area for 10 consecutive days followed by speech/ language training . The language section of the Hemispheric Stroke Scale ( HSS ) , the Stroke Aphasic Depression Question naire – Hospital Version ( SADQ-H ) , and the National Institutes of Health Stroke Scale ( NIHSS ) were measured before , immediately after the 10 sessions , and 1 and 2 months after the last session . Results . At baseline , there were no significant differences between groups in demographic and clinical rating scales . However , there was a significantly greater improvement in the HSS language score as well as in the SADQ-H after real rTMS compared with sham rTMS , which remained significant 2 months after the end of the treatment sessions . Conclusion . This is the first clinical study of dual-hemisphere rTMS in poststroke aphasia . Combining dual-hemisphere rTMS with language training might be a feasible treatment for nonfluent aphasia ; further multicenter studies are needed to confirm this result BACKGROUND Coronary artery bypass grafting ( CABG ) can be associated with postoperative cognitive impairment and ischemic stroke . No effective treatment is currently available . The aim of this study was to evaluate the effectiveness of piracetam to treat the cognitive impairment  after CABG in an investigator-initiated , double-blind , placebo-controlled , r and omized clinical trial . METHODS Patients undergoing CABG ( n = 98 ) were r and omized to placebo  ( n = 48 ) or  piracetam  ( n = 50 ) . Study drugs were administered intravenously ( 150 mg/kg daily ; 300 mg/kg on the day of surgery ) from the day before surgery to 6 days after surgery , then orally ( 12 g/day ) up to 6 weeks after surgery . Cognitive function was assessed before surgery ( baseline ) and 6 weeks after surgery ( outcome ) by using a battery of 12 neuropsychologic tests . The Spielberger Anxiety Inventory and the Beck Depression Inventory were also administered . The combined score derived from the st and ardized neuropsychologic assessment s was analyzed by using an analysis of covariance with baseline and education as covariates . RESULTS Six weeks after surgery , the combined score indicated a statistically significant treatment effect in the per protocol population ( 1.848 , p = 0.041 ) and a tendency towards statistical significance in the intent-to-treat population ( 1.624 , p = 0.064 ) in the group treated with piracetam , but no statistically significant treatment effect was seen in the placebo . The state of anxiety measured by the Spielberger Anxiety Inventory was decreased in both groups ( -9.27 and -6.37 in the placebo and piracetam groups , respectively ) . CONCLUSIONS Six weeks after CABG , cognition was significantly improved in patients treated with piracetam .  Additional trials are required to confirm these effects
Conclusions Piracetam plays a limited role in the rehabilitation of overall language impairment and only benefits written language ability at the end of trials .
Its effect on overall linguistic level and written language tends to emerge within a short period and declines thereafter
Background Aphasia is a common symptom in post-stroke patients .
Piracetam is a commonly used nootropic agent that promises various benefits to brain function , including language improvement .
Objective We performed a systematic review and meta- analysis to assess whether piracetam facilitates the rehabilitation of language performance in post-stroke patients .