dihydroergotoxine and Dementia

The pathogenesis of primary degenerative dementia is still unknown and current therapeutic approaches can aim only at ameliorating some of the symptoms associated with this brain disease. At present, most approaches, attempt to correct a cholinergic deficit. Although the therapeutic benefits obtained so far with currently available cholinergic drugs are generally modest, it appears that there exists a subgroup of responders. This offers some hope that more potent and more selective cholinergic drugs might be more effective. Recent findings suggest that the neurochemical pathology in degenerative dementia is not restricted to the cholinergic system but also includes pathways using monoamines as transmitters. Alternative strategies should therefore include drugs able to correct disturbances in monoaminergic systems. Hydergine and the novel drug CBM 36-733 are suitable candidates. Hydergine is approved by the FDA as being effective for the treatment of selected symptoms of cognitive decline in the elderly. Preliminary results of a 2-month study indicate that CBM 36-733 has beneficial effects in patients with mild to moderate degrees of degenerative dementia. Interestingly, CBM 36-733 also counteracts age-related decreases in choline acetyltransferase, a marker for cholinergic nerve terminals in experimental animals. It will therefore be of interest to clinically evaluate in long-term studies the potential of this drug to slow down the progression of neurodegenerative processes.

Topics: Dementia; Dihydroergotoxine; Humans; Neurotransmitter Agents; Parasympathomimetics

Topics: Adrenocorticotropic Hormone; Alzheimer Disease; Choline; Dementia; Dihydroergotoxine; Humans; Narcotic Antagonists; Peptide Fragments; Phosphatidylcholines; Physostigmine; Piracetam; Pyrrolidines; Succinimides

Topics: Alzheimer Disease; Animals; Brain; Dementia; Dihydroergotoxine; Humans; Models, Biological; Neurotransmitter Agents; Rats

No class of presently available drugs is able to alleviate the cognitive deficits which accompany senile dementia. The present article critically reviews the strategies which have until now been used to treat these deficits. A description is given of the cognitive deficits which are commonly seen and of the cerebral substrate underlying memory processes. Furthermore, the various treatment strategies are critically reviewed as well as the rationale behind the use of the currently available drugs. It is concluded that no clinically significant improvement of cognitive disturbances can be obtained with the present available drugs. The neuropeptide strategy however may reveal new pharmacotherapeutic possibilities in the near future.

Topics: Adrenocorticotropic Hormone; Aged; Alzheimer Disease; Anticonvulsants; Brain; Catecholamines; Choline; Dementia; Dihydroergotoxine; Humans; Memory Disorders; Narcotic Antagonists; Nerve Tissue Proteins; Neuropsychology; Parasympatholytics; Phosphatidylcholines; Physostigmine; Piracetam; Trace Elements; Vasopressins; Vitamins

Topics: Acetylcholine; Aged; Dementia; Dihydroergotoxine; Furans; Humans; Kinetics; Mesylates; Nafronyl; Parasympatholytics; Parasympathomimetics; Receptors, Neurotransmitter

Ergoloid mesylates has been used for 30 years to treat patients with senile dementia. Indications for this drug include hypertension, peripheral vascular disease, and senile dementia of the Alzheimer type. Formerly classified as a cerebral vasodilator, ergoloid mesylates is now considered a metabolic enhancer, but how this action pertains to treatment of senile dementia is uncertain. Prescribed doses of the drug range from 1.5 mg/d to as much as 12 mg/d, but the optimal dose is unknown. Although there is evidence of the short-term efficacy of ergoloid mesylates from numerous controlled trials, many clinicians still consider it to be a placebo. No alternative drug treatments have been proved better. The crucial decision a physician must make is whether to try specific drug therapy or rely solely on supportive care and symptomatic drug treatment. The increasing prevalence of senile dementia has renewed interest in discovering more effective drug treatments for this condition.

Topics: Alzheimer Disease; Animals; Brain; Cerebrovascular Circulation; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Drug Administration Schedule; Drug Utilization; Europe; Humans; United States; Vasodilator Agents

While their importance in the market-place is steadily increasing in developed (mainly continental Europe) and even in developing countries, compounds included in the broad category of 'cerebroactive' drugs hardly rate a mention in reference pharmacology and therapeutics textbooks. It is an undeniable fact, however, that the principal users or targets of this drug class, mainly elderly people, represent an increasingly worrying problem, with their often puzzling cohort of ill-definable and even less predictable neurological and mental symptoms. The combination of the above factors cannot but produce a rather confused situation, in which the pressure to treat and the adherence to scientifically rigorous assessment are likely to prevail alternately, on a purely casual basis. This review aims to provide sound methodological guidelines for assessment of 'cerebroactive' drugs in a not always easily accessible literature. It covers firstly the general problems of stroke, dementia and 'common symptoms' of the elderly, and then looks in detail at those compounds which have to date attracted most attention (ergot derivatives, cinnarizine, flunarizine, vincamine, eburnamonine, naftidrofuryl, oxpentifylline, piracetam and citicoline), as well as those which are currently considered investigational (choline and lecithin). The pharmacology and available clinical studies of each drug are examined. No therapeutic indication can be derived from the available evidence, as the few positive results do not go beyond random improvement of symptoms. More fundamentally, the lines of research which need to be pursued most intensively relate to better preliminary definition of diagnostic and prognostic criteria and, with the establishment of adequate testing tools for the assessment of behaviour and neuropsychological performance, those basal conditions which are modified 'naturally' or by drugs.

Topics: Adult; Aged; Cerebrovascular Disorders; Cinnarizine; Clinical Trials as Topic; Cytidine Diphosphate Choline; Dementia; Dihydroergotoxine; Humans; Middle Aged; Nafronyl; Pentoxifylline; Piracetam; Vasodilator Agents; Vincamine

Topics: Aged; Brain; Dementia; Dihydroergotoxine; Humans; Meclofenoxate; Nafronyl; Piracetam; Pyrithioxin; Vincamine

Topics: Aged; Aging; Anticoagulants; Arginine Vasopressin; Brain; Choline; Dementia; Dihydroergotoxine; Free Radicals; Glucose; Humans; Levodopa; Neurotransmitter Agents; Vasodilator Agents; Xanthinol Niacinate

Topics: Aged; Animals; Betahistine; Cerebrovascular Circulation; Cerebrovascular Disorders; Cinnarizine; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Humans; Isoxsuprine; Nicotinic Acids; Nylidrin; Rats; Receptors, Adrenergic; Receptors, Histamine; Vasodilator Agents; Vincamine

Topics: Adult; Age Factors; Aged; Alzheimer Disease; Amphetamine; Antidepressive Agents, Tricyclic; Dementia; Depression; Dihydroergotoxine; Female; Humans; Male; Memory; Methylphenidate; Papaverine; Procaine; Pyrrolidinones; Thioridazine

Topics: Aged; Anticoagulants; Central Nervous System Agents; Dementia; Dihydroergotoxine; Humans; Hypnotics and Sedatives; Mental Disorders; Neurocognitive Disorders; Papaverine; Parasympathomimetics; Piracetam; Vasodilator Agents

Topics: Adrenergic alpha-Antagonists; Aminophylline; Angina Pectoris; Bradycardia; Bronchial Diseases; Cerebrovascular Disorders; Coronary Circulation; Coronary Disease; Dementia; Dihydroergotoxine; Ethylamines; Furans; Humans; Hypotension; Injections, Intramuscular; Injections, Intravenous; Moxisylyte; Naphthalenes; Nitrates; Oxprenolol; Phenoxybenzamine; Practolol; Propionates; Propranolol; Vasodilator Agents

In a randomized trial lasting six weeks and involving 80 elderly patients with cerebrovascular disorders, the effectiveness and tolerance of dihydroergotoxine was compared with an extract of Ginkgo biloba. On the basis of psychometric tests and assessment scales, it was shown that treatment with either substance improved the condition of the patients. While, for the most part, intergroup comparison revealed no major statistically significant differences, such changes, affecting various parameters, were found during follow-up--more frequently within the dihydroergotoxine group than within the group treated with Ginkgo biloba extract.

Topics: Aged; Aged, 80 and over; Dementia; Dementia, Vascular; Dihydroergotoxine; Diterpenes; Female; Ginkgolides; Humans; Lactones; Male; Middle Aged; Plant Extracts; Randomized Controlled Trials as Topic

In a double-blind study of 41 outpatients aged 55 to 80 years with mild memory impairment, the efficacy of dihydroergotoxine mesylate (DEM, Hydergine) at 6 mg per day, administered orally, was tested during a twelve-week period. Specific etiologies for the amnesic syndrome were ruled out by history, physical examination, and laboratory tests. Subjects with a Hamilton Depression Scale rating above 18, ie, possible pseudodementia, were excluded. Physician rating of memory, employing the Inventory of Psychic and Somatic Complaints in the Elderly (IPSC-E), indicated statistically significant improvement of memory function in DEM treated subjects (N = 22) v those on placebo (N = 19), (F = 3.34; df = 1,39; P less than .04). In contrast, structured testing of recent memory using digit symbol substitution and Zahlenverbindungs test (ZVT) showed improvement in both groups (P less than .001) with no significant intergroup differences (P less than .10). Out results indicate that in cases of mild, though subjectively distressing impairment, DEM at higher dosages may help to enhance short-term memory function.

Topics: Affect; Aged; Behavior; Cognition; Dementia; Dihydroergotoxine; Double-Blind Method; Female; Humans; Male; Memory, Short-Term; Middle Aged; Psychiatric Status Rating Scales

Seventy-six patients took part in a randomized, comparative study of the efficacy of buflomedil hydrochloride and dihydrogenated ergot alkaloids in the treatment of senile dementia associated with cerebrovascular insufficiency. Efficacy was assessed by the patients' performance in four psychometric tests. The results showed that a trend in favour of the buflomedil group in three of the tests became statistically significant in the fourth. Both drugs appeared to be safe, causing no marked adverse reactions. In conclusion, buflomedil is as effective or more effective than dihydrogenated ergot alkaloids in the treatment of senile dementia associated with cerebrovascular insufficiency and could prove a valuable addition to long-term therapy if further studies support the trend shown in this study.

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Female; Humans; Male; Middle Aged; Psychological Tests; Pyrrolidines; Random Allocation; Vasodilator Agents

Topics: Clinical Trials as Topic; Dementia; Dihydroergotoxine; Double-Blind Method; Evoked Potentials, Auditory; Humans

The behaviour of regional cerebral blood flow was studied in 90 patients with vascular type dementia. Patients were divided at random into three groups of 30 and treated 3-times daily over a period of 8 weeks with either 400 mg pentoxifylline ('Trental' 400) or 2 mg co-dergocrine mesylate, or remained untreated (control group). Measurements of regional cerebral blood flow were made before and after 4 and 8 weeks of the study using an atraumatic inhalative 133Xenon clearance technique and assessments made in 16 regions of interest per hemisphere (grey matter perfusion). A statistically significant increase over baseline in mean regional cerebral blood flow was found in patients on pentoxifylline medication at Weeks 4 and 8. At Week 8, the change from baseline was +16.4% in the pentoxifylline group whereas the respective values for the other two groups were +0.4% for co-dergocrine mesylate, -2.4% for the controls. Hypoemic regions showed the most pronounced regional cerebral blood flow changes with pentoxifylline (+40%), the corresponding values for the co-dergocrine mesylate and control group being +10.8% and +0.4%, respectively.

Topics: Aged; Blood Flow Velocity; Cerebrovascular Circulation; Dementia; Dihydroergotoxine; Female; Humans; Male; Middle Aged; Pentoxifylline; Radionuclide Imaging; Random Allocation; Regional Blood Flow; Theobromine; Time Factors; Xenon Radioisotopes

Ergoloid mesylates has been used for 30 years to treat patients with senile dementia. Indications for this drug include hypertension, peripheral vascular disease, and senile dementia of the Alzheimer type. Formerly classified as a cerebral vasodilator, ergoloid mesylates is now considered a metabolic enhancer, but how this action pertains to treatment of senile dementia is uncertain. Prescribed doses of the drug range from 1.5 mg/d to as much as 12 mg/d, but the optimal dose is unknown. Although there is evidence of the short-term efficacy of ergoloid mesylates from numerous controlled trials, many clinicians still consider it to be a placebo. No alternative drug treatments have been proved better. The crucial decision a physician must make is whether to try specific drug therapy or rely solely on supportive care and symptomatic drug treatment. The increasing prevalence of senile dementia has renewed interest in discovering more effective drug treatments for this condition.

Topics: Alzheimer Disease; Animals; Brain; Cerebrovascular Circulation; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Drug Administration Schedule; Drug Utilization; Europe; Humans; United States; Vasodilator Agents

A double-blind study of 24 weeks' duration was conducted to investigate the effects of ergoloid mesylates (Hydergine) on symptoms of senile mental deterioration. Fifty-eight residents of old people's homes were included in the trial. Thirty were treated with ergoloid mesylates and 28 with placebo, and the effects of treatment were determined by means of medical and psychological examinations. On the Sandoz Clinical Assessment Geriatric Scale, the group receiving ergoloid mesylates showed significant improvement in all items. The group receiving placebo showed slight deterioration. Psychological examination showed that no changes were observed for either group in quantitative psychometric test results, although qualitative aspects of performance such as attention and concentration did improve. There was a close correlation between improved cognitive function scores on the SCAG and improved evaluations of behavior during the psychological examinations. There were marked individual differences in the degrees of improvement.

Topics: Aged; Clinical Trials as Topic; Cognition Disorders; Dementia; Dihydroergotoxine; Double-Blind Method; Female; Homes for the Aged; Humans; Male; Placebos; Psychiatric Status Rating Scales; Psychological Tests

Topics: Aged; Dementia; Dihydroergotoxine; Drug Administration Schedule; Female; Furans; Humans; Male; Nafronyl

The aim of the trial was to compare the clinical efficacy of dihydroergotoxin with a placebo, and to define its indications in the treatment of acquired dementia of abiotrophic origin (degeneration by primary cerebral atrophy) or arteriopathic (deterioration as the result of multiple cerebral infarcts) origin. It was a single centre, double-blind, randomized, controlled, experimental clinical trial. The trial involved 3 groups, each corresponding to a stage of increasing severity. Each group was randomized separately. The separation between the abiotrophic dementia group and the arteriopathic dementia group was made after the trial, on the basis of clinical criteria (Hachinski ischemic score), and a scan when applicable. The number of subjects necessary was fixed at 100 (33 per group). The duration of the trial was 6 months per patient.

Topics: Aged; Cerebrovascular Disorders; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Middle Aged; Random Allocation; Research Design

While their importance in the market-place is steadily increasing in developed (mainly continental Europe) and even in developing countries, compounds included in the broad category of 'cerebroactive' drugs hardly rate a mention in reference pharmacology and therapeutics textbooks. It is an undeniable fact, however, that the principal users or targets of this drug class, mainly elderly people, represent an increasingly worrying problem, with their often puzzling cohort of ill-definable and even less predictable neurological and mental symptoms. The combination of the above factors cannot but produce a rather confused situation, in which the pressure to treat and the adherence to scientifically rigorous assessment are likely to prevail alternately, on a purely casual basis. This review aims to provide sound methodological guidelines for assessment of 'cerebroactive' drugs in a not always easily accessible literature. It covers firstly the general problems of stroke, dementia and 'common symptoms' of the elderly, and then looks in detail at those compounds which have to date attracted most attention (ergot derivatives, cinnarizine, flunarizine, vincamine, eburnamonine, naftidrofuryl, oxpentifylline, piracetam and citicoline), as well as those which are currently considered investigational (choline and lecithin). The pharmacology and available clinical studies of each drug are examined. No therapeutic indication can be derived from the available evidence, as the few positive results do not go beyond random improvement of symptoms. More fundamentally, the lines of research which need to be pursued most intensively relate to better preliminary definition of diagnostic and prognostic criteria and, with the establishment of adequate testing tools for the assessment of behaviour and neuropsychological performance, those basal conditions which are modified 'naturally' or by drugs.

Topics: Adult; Aged; Cerebrovascular Disorders; Cinnarizine; Clinical Trials as Topic; Cytidine Diphosphate Choline; Dementia; Dihydroergotoxine; Humans; Middle Aged; Nafronyl; Pentoxifylline; Piracetam; Vasodilator Agents; Vincamine

Topics: Aged; Clinical Trials as Topic; Delayed-Action Preparations; Dementia; Dihydroergotoxine; Female; Humans; Male

Topics: Aged; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Double-Blind Method; Drug Tolerance; Female; Humans; Hypertension; Male

Topics: Aged; Animals; Betahistine; Cerebrovascular Circulation; Cerebrovascular Disorders; Cinnarizine; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Humans; Isoxsuprine; Nicotinic Acids; Nylidrin; Rats; Receptors, Adrenergic; Receptors, Histamine; Vasodilator Agents; Vincamine

The results of a 3-month trial with an ergot alkaloid preparation (Hydergine) in 16 geriatric patients showed that, in accordance with a previously proposed working hypothesis, the improvement induced by the drug in electroencephalographic age-related changes was accompanied by clinical improvement in patients with similarly age-related mental deterioration.

Topics: Affective Symptoms; Aged; Alpha Rhythm; Anxiety; Arousal; Clinical Trials as Topic; Dementia; Depression; Dihydroergotoxine; Double-Blind Method; Electroencephalography; Female; Humans; Male; Middle Aged

A compound of ergot alkaloids (Hydergine-Sandoz) or placebo was given to sixty elderly nursing home patients with non-psychotic organic brain syndrome. Subsequent to 12 weeks of treatment, the mean serum prolactin of the drug was significantly lower than that of the placebo group. No correlation was found between changes in prolactin and changes in behavior using Sandoz Assessment of Clinical Status Rating Form-Geriatric [SCAG]. It may be that a higher dose of Hydergine with an accompanying greater drop in prolactin would be required to observe this effect.

Topics: Aged; Dementia; Dihydroergotoxine; Female; Humans; Male; Prolactin; Substance Withdrawal Syndrome

In 14 patients with senile dementia, a study was made of two dosage levels (3 mg or 6 mg daily) of dihydroergotoxine mesylate (DEM, Hydergine). Only a nonstatistically significant trend was found for superiority of the higher dosage. However, one patient showed remarkable clinical improvement during the 6-mg period; the mechanism remains unexplained. Further studies are needed with this higher dosage in less impaired patients and in those with well-defined cerebral pathologic changes.

Topics: Aged; Dementia; Dihydroergotoxine; Double-Blind Method; Female; Humans; Male; Middle Aged

Dementia is a symptom complex probably arising from cerebral metabolic insufficiency. The testing of drugs thought to improve cerebral metabolism is difficult and many problems have to be overcome. Assessment of brain failure requires objective tests of intellect and memory. Subjective tests are used for disorders of personality and affect. The most useful and practical tests are described in detail. Clinical trials have to be double-blind with strict control of all factors which may influence the tests. Hydergine has been tested in 1,300 patients and shown to be an effective therapeutic agent.

Topics: Aged; Aging; Brain; Clinical Trials as Topic; Dementia; Diagnosis, Differential; Dihydroergotoxine; Double-Blind Method; Drug Evaluation; Female; Humans; Male; Methods; Psychological Tests; Research Design

A prospective study over 15 months in 100 elderly patients with signs of cerebro-vascular impairment demonstrated by psychometric testing that Hydergine (an ergot alkaloid preparation: 4.5 mg daily) compensated the signs of dementia, present in the placebo group, and in some patients actually brought about a significant improvement in mental activity. Similar compensatory effect was also demonstrable in cerebral haemodynamics: in the placebo group there was a progressive increase in cerebral circulation time, an expression of decreased cerebral blood flow, while with Hydergine cerebral circulation time was shortened and stabilized. Serial EEGs, obtained in parallel with psychometric and circulation time tests, demonstrated a marked increase in the 8-10 Hz pattern which corresponds to the physiological alpha activity in this age group. Furthermore, there was a diminished variability in performance in the tested frequency bands with Hydergine, the opposite tendency being obtained in the placebo group.

Topics: Aged; Cerebrovascular Circulation; Cerebrovascular Disorders; Dementia; Dihydroergotoxine; Double-Blind Method; Electroencephalography; Humans; Placebos; Prospective Studies; Psychological Tests; Time Factors

Topics: Aged; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Double-Blind Method; Humans; Papaverine

A critical review is presented of 12 clinical trials with Hydergine (a hydrogenated ergot alkaloid preparation) in the treatment of dementia. Qualitative and quantitative comparisons of improvement in symptoms showed that Hydergine consistently produced statistically significant (p less than or equal to 0.05) improvement in 13 symptoms associated with dementia. However, because of the small magnitude of the improvement and the absence of indications of long-term benefit, Hydergine would seem to be of minor value in dementia therapy. Further research with better methodology and design might lead to a different conclusion.

Topics: Activities of Daily Living; Affect; Aged; Cerebrovascular Circulation; Clinical Trials as Topic; Cognition; Dementia; Dihydroergotoxine; Drug Evaluation; Ergoloid Mesylates; Humans; Intracranial Arteriosclerosis; Neurologic Manifestations; Personality; Placebos; Psychological Tests

Topics: Age Factors; Aged; Anxiety Disorders; Attitude; Brain; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Ergoloid Mesylates; Evaluation Studies as Topic; Female; Humans; Life Style; Male; Memory Disorders; Mental Disorders; Middle Aged; Papaverine; Placebos; Time Factors

This is the first double-blind study in outpatients to evaluate the effectiveness of dihydrogenated ergot alkaloids (DEA) (Hydergine) versus papaverine in the treatment of selected symptoms associated with mental aging. In addition, this is the first study comparing these two pharmacologic agents in relatively young geriatric patients, with a mean age in the mid-sixties. After twelve weeks of treatment, ratings of overall clinical condition and global change showed that the 26 patients given DEA improved more than twice as much as the 27 patients given papaverine. Of the 14 individual symptoms rated, 13 improved significantly more in the DEA group than in the papaverine group. These symptoms included confusion, dizziness, unsociability, depressive mood, and mental alertness. Other data confirmed the generally superior results with DEA. In view of its demonstrated beneficial clinical actions and of its notable scarcity of contraindications or side effects, DEA appears to represent a significant pharmacologic contribution to the care of elderly persons showing selected symptoms of mental and functional decline.

Topics: Aged; Aging; Clinical Trials as Topic; Confusion; Dementia; Depression; Dihydroergotoxine; Ergoloid Mesylates; Female; Humans; Male; Middle Aged; Papaverine; Placebos; Social Behavior Disorders; Time Factors; Vertigo

Topics: Aged; Aged, 80 and over; Dementia; Dihydroergotoxine; Double-Blind Method; Female; Geriatric Psychiatry; Humans; Male

Topics: Aged; Dementia; Dihydroergotoxine; Female; Humans; Hypertension; Male; Methyldopa; Middle Aged; Posture; Random Allocation

Topics: Aged; Alzheimer Disease; Antidepressive Agents; Antipsychotic Agents; Brain; Dementia; Diagnosis, Differential; Dihydroergotoxine; Female; Humans; Male; Middle Aged; Naloxone

Topics: Aged; Alzheimer Disease; Dementia; Dihydroergotoxine; Humans; Nafronyl; Papaverine; Pentoxifylline; Piracetam; Procaine; Psychotropic Drugs

Topics: Aged; Alzheimer Disease; Cerebrovascular Circulation; Dementia; Dihydroergotoxine; Humans

Topics: Dementia; Dihydroergotoxine; Humans

Topics: Alzheimer Disease; Animals; Brain; Cerebrovascular Circulation; Combined Modality Therapy; Dementia; Depressive Disorder; Dihydroergotoxine; Double-Blind Method; Energy Metabolism; Humans; Meclofenoxate; Neurotransmitter Agents; Piracetam; Psychotherapy; Pyrithioxin

In order to promote optimal characterization of new drugs for the psychogeriatric patient, a clear delineation of both patients and therapies is needed. Diagnostic evaluation of the patient includes a careful differential diagnosis, a definition of target symptoms and an evaluation of severity and stage of disease. Criteria for assessment of drug efficacy must take into account the pharmacological effects of the drug, the hypothesis to be investigated and the target population. Drug assessment should include indicators of drug activity such as physiological, biochemical or psychometric measurements. In order to facilitate progress in geriatric psychopharmacology, full use should be made of the various hypothesis for drug treatment originating from the rapid advancement in our understanding of the biological basis of senile mental incapacitation.

Topics: Aged; Dementia; Dihydroergotoxine; Drug Evaluation; Geriatric Psychiatry; Humans; Mental Disorders; Prolactin; Psychometrics; Psychopharmacology

Patients with "mild to moderate" dementia might improve with appropriate drug therapy whereas patients with "severe" dementia are generally considered to have an irreversible condition, providing acute metabolic disorders have been excluded and appropriate investigations have been performed to exclude neurological conditions that might be amenable to neurosurgery. Since it is unlikely that this type of patient will be referred to the hospital outpatient clinics, it is necessary to identify these patients in the community. For this purpose, authors have used the Abbreviated Mental Test. A comparison between two observers (nurse and doctor) has been made. Subsequently, a 6 symptoms check-list, as abbreviated form of the Crichton Royal Rating Scale for geriatric patients, was used in an open pilot study on 260 patients completing a 12 weeks treatment by dihydroergotoxine mesylate (codergocrine mesylate, Hydergine) 4.5 mg once a day. Although this was an open pilot study, it does show that it is possible to identify and treat patients with "mild to moderate" dementia in the community. A single dose formulation in the elderly has obvious advantages. In this study, compliance was excellent and 88% of the patients showed significant improvement using the suggested rating scales.

Topics: Ambulatory Care; Analysis of Variance; Dementia; Dihydroergotoxine; Evaluation Studies as Topic; Follow-Up Studies; Humans; Intelligence Tests; Prognosis; Psychiatric Department, Hospital

Topics: Aged; Dementia; Dihydroergotoxine; Humans

Either supportive counseling (SC) or cognitive training (CT) was used in an attempt to enhance the efficiency of a standard pharmacologic treatment for dementia, viz, dihydroergotoxine mesylate (DEM, Hydergine). DEM was administered orally to 21 moderately demented subjects, in a dosage of 1 mg three times daily; and SC or CT was conducted for one hour every two weeks for a total of 12 weeks. The CT was designed to enhance memory and other intellectual functions by the teaching of organizational schemes and mnemonic devices. Outcome measurements included the Sandoz Clinical Assessment-Geriatric (SCAG), a behavioral rating scale measuring selected symptoms and signs of dementia; the Hamilton Rating Scale for Depression (HRSD); and the Buschke Selective Reminding Scale (BSRT), a psychometric test of memory and learning. The DEM + CT group of patients improved more than did the DEM + SC group for the measures of memory and learning (BSRT). However, no differences between groups were noted for the HRSD or SCAG behavioral measures.

Topics: Aged; Cognition; Dementia; Dihydroergotoxine; Humans; Psychotherapy

Topics: Aged; Alzheimer Disease; Dementia; Dihydroergotoxine; Dose-Response Relationship, Drug; Female; Humans; Male

Topics: Aged; Choline; Dementia; Dihydroergotoxine; Female; Humans; Male; Memory; Middle Aged; Piracetam

Topics: Aged; Antidepressive Agents, Tricyclic; Central Nervous System Stimulants; Choline; Dementia; Dihydroergotoxine; Humans; Hypnotics and Sedatives; Middle Aged; Phosphatidylcholines; Tranquilizing Agents; Vasodilator Agents

After setting up a catalogue of complaints and signs for the most frequent disturbances of feeling tone of the patients suffering from cerebral arteriosclerosis, consisting of somatically subjective head pain and mental disturbances, treatment was given to 33 patients with cerebrovascular disturbances and 7 patients with similar, although non-vascular, disturbances (4 patients with presenile dementia, 3 patients with tinnitus in otosclerosis), the treatment consisting of eutergin 3 X 1 tablets to 3 X 2 tablets daily, the concomitant cardio-internistic medication remaining the same throughout the treatment course. The type and severity of the symptoms prevailing in each case were determined at the beginning, after 3 weeks and after 6 weeks of the medication with eutergin. It was found that improvement of the somatic-subjective head pain was more pronounced than that of the mental disturbances. Generally speaking, the disturbing somatic or mental signs were those which could be influenced better than the others. As far as the head pain was concerned, the feeling of giddiness, congestion in the head, rapid exhaustion, above all, tinnitus, responded best to the medication (the improvement amounting to approximately 40%), whereas of the mental complaints, a feeling of being "lost" or "abandoned" and a morose mood were most amenable to improvement (degree of improvement approximately 30%). The prevention of the delirogenic effect of antidepressives in senile depression was a remarkable effect; this means that effective antidepressive medication is made possible with the help of eutergin, EEG controls did not reveal any significant effects. There were no side effects. Elevated blood pressure levels showed a tendency to become normal without any dramatic drops. Hence, eutergin is recommended in all kinds of chronic cerebrovascular lesions, provided it is associated with concomitant cardiac and internistic treatment.

Topics: Aged; Antidepressive Agents; Cerebrovascular Disorders; Chronic Disease; Dementia; Dihydroergotoxine; Drug Combinations; Electroencephalography; Headache; Humans; Mental Disorders; Middle Aged; Neurocognitive Disorders; Otosclerosis; Papaverine; Sparteine; Tinnitus

Topics: Aged; Alzheimer Disease; Dementia; Dihydroergotoxine; Humans; Middle Aged; Research

Topics: Aged; Clinical Trials as Topic; Dementia; Dihydroergotoxine; Humans; Psychiatric Status Rating Scales; Social Adjustment

Topics: Aged; Cerebrovascular Circulation; Dementia; Dihydroergotoxine; Double-Blind Method; Ergot Alkaloids; Humans; Nicergoline; Papaverine; Psychiatric Status Rating Scales

With careful differential diagnosis and judicious treatment, you may be able to reverse certain aspects of dementia in the elderly. Drug toxicity, depression, metabolic and endocrine disorders, and other systemic problems are all potentially treatable causes of mental deterioration. Even when the cause cannot be identified, you can still treat the patient's symptoms. Antidepressants, antipsychotics, and antianxiety agents, plus supportive measures, often effect marked improvement.

Topics: Antidepressive Agents, Tricyclic; Dementia; Depression; Diagnosis, Differential; Dihydroergotoxine; Drug-Related Side Effects and Adverse Reactions; Humans; Mental Disorders; Neurotransmitter Agents; Oxazepam; Thioridazine; Vasodilator Agents

The rationale for the use of vasodilators in the aged has changed from the attempt to increase cerebral blood flow to the attempt to improve cerebral metabolism. Review of 102 studies of eight vasodilators showed that significantly more controlled studies claimed practical clinical benefit from drugs supposed to improve neuronal intermediary metabolism with secondary vasodilatation than from drugs supposed to have only vasodilator action (P less than .005). Studies of both classes of drugs often suffered from poor study design, inappropriate and inconsistent application of outcome measurements, as well as negative bias due to selection of severely demented subjects. Future studies should be placebo-controlled investigations of drugs with primarily metabolic action, address questions of dose and time response, consistently use appropriate outcome measurement, and concentrate on the elderly in whom cognitive improvement is possible.

Topics: Aged; Cinnarizine; Cyclandelate; Dementia; Dihydroergotoxine; Drug Evaluation; Humans; Isoxsuprine; Mental Processes; Nafronyl; Papaverine; Pyrithioxin; Vasodilator Agents

Topics: Alzheimer Disease; Dementia; Dihydroergotoxine; Humans

Topics: Dementia; Dihydroergotoxine; Humans

Topics: Aged; Dementia; Dihydroergotoxine; Humans; Nafronyl; Vasodilator Agents

This report reviews 26 clinical drug trials which investigated the effectiveness of Hydergine, a dihydrogenated ergot alkaloid, used frequently in geriatric psychopharmacology. The methodological characteristics and significant results for each study are presented in outline form. In total, 32 symptoms were assessed in six or more studies. Therapeutic benefits following Hydergine treatment occurred in the areas of cognitive dysfunctions, mood depression, and the composite scores as measured by subjective clinical behavioral rating scales. It is suggested that the improvement reported in cognitive functions and mood depression is a reflection of the global change observed by clinicians in patients' overall behavior duirng the interview. This conclusion that Hydergine does produce some global improvement indicates that further research with Hydergine is warranted, provided more objective instruments are employed such as those described in the report.

Topics: Aged; Cerebrovascular Circulation; Dementia; Dihydroergotoxine; Double-Blind Method; Electroencephalography; Female; Humans; Male; Psychological Tests

Topics: Aging; Animals; Arteriosclerosis; Cerebrovascular Circulation; Dementia; Dihydroergotoxine; Disease Models, Animal; Dogs; Energy Metabolism; Glucose; Humans; Hypoxia, Brain; Memory; Neurons; Partial Pressure; Rabbits; Vincamine

Topics: Aged; Brain Damage, Chronic; Dementia; Dihydroergotoxine; Humans; Intracranial Arteriosclerosis; Mental Disorders; Monoamine Oxidase Inhibitors; Procainamide; Psychotropic Drugs; Tranquilizing Agents

Topics: Aged; Cyclandelate; Dementia; Dihydroergotoxine; Female; Humans; Male; Nafronyl

Topics: Aged; Cyclandelate; Dementia; Dihydroergotoxine; Drug Evaluation; Humans; Mental Processes; Papaverine

A survey conducted at 12 VA hospitals included the collection of detailed information on the use of psychoactive drugs in 1,276 elderly psychiatric patients. On the day of the survey, 61 per cent of the patients were receiving psychoactive drugs. Prescription practices relating to the choice of drugs, prevalence of drug use, dosage, combination drug preparations, and antiparkinson agents are discussed in terms of such factors as the patient's age and the diagnosis. Also discussed is the literature on psychoactive drugs, particularly as it pertains to elderly populations.

Topics: Aged; Anti-Anxiety Agents; Antidepressive Agents; Antiparkinson Agents; Antipsychotic Agents; Anxiety; Benzodiazepines; Brain; Brain Damage, Chronic; Dementia; Dihydroergotoxine; Drug Therapy, Combination; Ergoloid Mesylates; Female; Health Surveys; Hospital Units; Hospitals, Veterans; Humans; Male; Mental Disorders; Phenothiazines; Schizophrenia; United States; Vasodilator Agents

Topics: Aged; Bradycardia; Cerebrovascular Disorders; Dementia; Dihydroergotoxine; Ergoloid Mesylates; Female; Humans; Male

Topics: Aged; Cyclandelate; Dementia; Dihydroergotoxine; Female; Humans; Isoxsuprine; Male; Meclofenoxate; Middle Aged; Nafronyl; Nicotinic Acids; Theobromine; Vasodilator Agents; Xanthinol Niacinate

Topics: Arteriosclerosis; Biomedical Research; Cerebrovascular Disorders; Dementia; Dihydroergotoxine; Ergoloid Mesylates; Ergot Alkaloids; Geriatrics; Humans; Hypertension; Intracranial Arteriosclerosis; Psychotic Disorders; Toxicology