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Effects of piracetam on the dexamethasone suppression test in Alzheimer's and multi-infarct dementias

Published online by Cambridge University Press:  16 April 2020

G Charles ,
MJ Panzer ,
R Machowski ,
A Lefevre  and
J Mirel
G Charles
Affiliation:
Service de Psychiatrie, Centre Hospitalier Universitaire Vesale, 706 route de Gozée, B 6110Montigniy-le-Tilleul, Belgium
MJ Panzer
Affiliation:
Department of Psychiatry, University of Michigan, Ann Arbor, Ml 48109, USA
R Machowski
Affiliation:
Hôpital Vincent Van Gogh, B 6030, Marchienne-au-Pont, Belgium
A Lefevre
Affiliation:
Service de Psychiatrie, Centre Hospitalier Universitaire Vesale, 706 route de Gozée, B 6110Montigniy-le-Tilleul, Belgium
J Mirel
Affiliation:
Service de Psychiatrie, Centre Hospitalier Universitaire Vesale, 706 route de Gozée, B 6110Montigniy-le-Tilleul, Belgium
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Summary

Results of the dexamethasone suppression test (DST) in demented nondepressed patients have varied considerably, and there is evidence that these depend on the type of dementia, ie, Alzheimer’s disease (AD) or multi-infarct dementia (MID). AD is characterized by decreased central acetylcholine (Ach) activity, while MID is thought to be vascular in etiology. Pirecetam normalizes cerebral blood flow, along with other positive hemorheological properties. It may also increase central Ach levels. We performed the DST twice, 1 week apart, on 96 stable, demented geriatric inpatients. In 33 (21 AD, 11 MID), piracetam was started at an oral dose of 4.8 g/d 4-6 months before the first DST. The remaining 64 (39 AD, 25 MID) were untreated. Among untreated patients, those with MID were less suppressible (P < 0.001 and P= 0.01) and had more week-to-week variability (P = 0.0006) in the DST than AD patients. This is consistent with our previous findings. However, treated patients showed no difference in either postdexamethasone cortisol levels or reproducibility of DST results. We interpret these findings to mean that piracetam, by increasing central Ach, makes AD patients less suppressible on the DST, and by maintaining more constant limbic blood flow, makes MID patients more DST stable.

Keywords

acetylcholineAlzheimer’s diseasedementiadexamethasone suppression testmodified ischemic scoremulti-infarct dementiapiracetamSandoz Clinical Assessment Geriatric Scale
Type
Original article
Information
European Psychiatry , Volume 6 , Issue 4 , 1991 , pp. 195 - 200
Copyright
Copyright © Elsevier, Paris 1991

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