Abstract
In a double-blind, placebo-controlled study on the therapeutic efficacy and central effects of nicergoline, an ergot alkaloid with metabolic, antithrombotic and vasoactive action, 112 patients with mild to moderate dementia, diagnosed according to DSM IIIR criteria criteria (MMS 13-25), living in pensioners' homes, were included. Fifty-six were subdiagnosed as senile dementia of the Alzheimer type (SDAT), 56 as multi-infarct dementia (MID), based on computed tomography and Hachinski scores (≤49 SDAT, ≥7 MID). They received, after 2 weeks' run-in period (placebo), randomized for 8 weeks either 2 × 30 mg nicergoline (NIC) or 2 × 1 placebo (PLAC) orally. The four subgroups (SDAT/NIC, SDAT/PLAC, MID/NIC, MID/PLAC; 4 × 28 patients) were comparable in regard to age and sex. Only four, four, four and two patients of the respective groups did not finish the study for minor reasons. Confirmatory statistical analysis demonstrated in the target variable — the Clinical Global Impression (CGI) — a significant superiority of NIC over PLAC in both the SDAT and MID groups. Global improvement (CGI item 2) was seen in both nicergoline subgroups (3 and 3), while no changes occurred under placebo (4 and 4, respectively). The responder versus non-responder ratio was in the SDAT/NIC group 16/8, versus 8/16 in the SDAT/PLAC group (χ2=4.1,P=0.04); in the MID/NIC group 17/7, versus 7/19 in the MID/PLAC group (χ2=7.96,P<0.005). Furthermore, there was a significant improvement of the Mini-Mental State and the SCAG score in both the MID and SDAT group after 8 weeks of nicergoline, which was significantly superior to the minimal improvement or no change in placebo-treated SDAT and MID patients. EEG mapping demonstrated in NIC-treated SDAT and MID patients a significant decrease in delta and theta, increase in alpha 2 and beta activity and an acceleration of the centroid of the total power spectrum as compared with pretreatment, while opposite changes occurred in PLAC-treated SDAT and MID patients. The differences between PLAC and NIC reached the level of statistical significance. Event-related potential (ERP) recordings demonstrated a significantly shortened P300 latency under NIC treatment in both SDAT and MID patients, while there was a trend towards lengthening under PLAC. Thus, nicergoline improved vigilance and information processing at the neurophysiological level, which leads at the behavioural level to clinical improvement both in degenerative and vascular dementia.
Similar content being viewed by others
References
Abt K (1988) Descriptive data analysis (DDA) in quantitative EEG studies. In: Samson-Dollfus D, Guieu JD, Gotman J, Etevenon P (eds) Statistics and topography in quantitative EEG. Elsevier, Amsterdam, pp 150–160
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, third edition, revised, American Psychiatric Association, Washington, DC
Anderer P, Saletu B, Kinsperger K, Semlitsch H (1987) Topographic brain mapping of EEG in neuropsychopharmacology — part I. Methodological aspects. Meth Find Exp Clin Pharmacol 9 [6]:371–384
Anderer P, Semlitsch HV, Saletu B, Barbanoj MJ (1992) Artifact processing in topographic mapping of electroencephalographic activity in neuropsychopharmacology. Psychiatry Res 45:79–93
Arrigo A, Moglia A, Borsotti L, Massarini M, Alfonsi E, Battaglia A, Sacchetti GA (1982) Double-blind, placebo-controlled, cross-over trial with nicergoline in patients with senile dementia. Int J Clin Pharm Res 2[1]:33–41
Bartels PH, Subach JA (1976) Automated interpretation of complex scenes. In: Preston E, Onoe M (eds) Digital processing of biomedical imagery. Academic Press, New York, pp 101–114
Battaglia A, Bruni G, Ardia A, Sacchetti G (1989) Nicergoline in mild to moderate dementia. A multicenter, double-blind, placebo-controlled study. Jags 37:295–302
Bente D, Glatthaar G, Ulrich G, Lewinsky M (1979) Quantitative EEG-Untersuchungen zur vigilanzfördernden Wirkung von Nicergolin. Ergebnisse einer Doppelblindstudie bei gerontopsychiatrischen Patienten. Arzneimittelforschung 29:1804–1808
Benzi G, De Bernardi M, Manzo L, Ferrara A, Panceri P, Arrigoni E, Berte F (1972) Effect of lysergide and nicergoline on glucose metabolism investigated on the dog brain isolated in situ. J Pharm Sci 61[3]:348–352
Benzi G, Arrigoni E, Pastoris O, Villa RF, Dagani F, Marzatico F, Agnoli A (1979) Effect of some drugs on cerebral energy state during and after hypoxia and complete or incomplete ischemia. Biochem Pharmacol 28:435–439
Berner, P (1977) Psychiatrische Systematik. Huber, Bern - Stuttgart - Wien
Borromei A (1989) Adjuvant therapy for Parkinson's disease. Preliminary data of a multicentre study with nicergoline. Funct Neurol 4:63–67
Chandra P, Paul A (1985) The effects of nicergoline and other vasoactive substances on molecular biological processes in the brain and their effects on the learning abilities of rats. In: Heidrich H (ed) Proof of therapeutic effectiveness of nootropic and vasoactive drugs. Springer, Berlin, Heidelberg, New York, Tokyo, pp 119–130
Dolce G, Cecconi V, Zamponi A, Zylbergmann R, Maggi L, Battaglia A (1985) Terapia farmacologica associata a riabilitazione neuromotoria nel paziente: un nuovo approccio metodologico per la valutazione clinica di farmaci nootropi. Giorn Geront (suppl) 62:55–63
Duffy FH, Bartels PH, Burchfield JL (1981) Significance probability mapping: An aid in the topographic analysis of brain electrical activity. Electroencephalogr Clin Neurophysiol 51:455–462
Ehrly AM, Landgraf H (1985) Einfluß von Nicergolin auf die Filtrabilität hyperosmolaren Blutes. In: Heidrich H (ed) Therapeutische Wirksamkeitsnachweise bei nootropen und vasoaktiven Substanzen: Fortschritte in der klinischen und experimentellen Nicergolin-Forschung. Springer, Berlin, Heidelberg, New York, Tokyo, S 189
Fischhof PK, Wagner G, Litschauer G, Apecechea M, Hiersemenzel R, Röhmel J, Rüther E, Hoffmeister F, Schmage N (1989) Therapeutic results with nimodipine in primary degenerative dementia and multi-infarct dementia. In: Bergener M, Reisberg B (eds) Diagnosis and treatment of senile dementia. Springer, Berlin, pp 350–359
Fischhof PK, Saletu B, Rüther E, Litschauer G, Möslinger-Gehmayr R, Herrmann WM (1992) Therapeutic efficacy of pyritinol in patients with senile dementia of the Alzheimer type (SDAT) and multi-infarct dementia (MID). Neuropsychobiology 26:65–70
Folstein MF, Folstein SE, Mc Hugh PR (1975) Mini Mental State: a practical method for grading the cognitive state of patients for the clinican. J Psychiatr Res 12:189–198
Gasser T, Bächer P, Möcks J (1982) Transformation towards the normal distribution of broad band spectrum parameters of the EEG. Clin Neurophysiol 43:119–124
Gessner B, Thomalske G, Musil J, Jobst E (1979) Bestimmung der EEG-Aktivität und der Bioverfügbarkeit von Nicergolin mittels quantitative EEG-Analysen. Arzneimittelforschung 29:1282–1287
Granata M, Dondero D, Tomasinelli R (1984) Studio clinico controllato della nicergolina dell' insufficienza cerebrale senile. Atti Accad Med Lomb 39:33–40
Hachinski VC, Iliff LD, Zilhka E, Du Boulay GH, McAllister VL, Marshall J, Russell RR, Symon L (1975) Cerebral blood flow in dementia. Arch Neurol 32:632–637
Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc clin Psychol 6:278–296
Head H (1923) The conception of nervous and mental energy. II. Vigilance: a physiological state of the nervous system. Br J Psychol 14:125–147
Heitz C, Descombes JJ, Miller RC, Steclet JC (1986) Alpha-adrenoceptor antagonistic and calcium antagonstic effects of nicergoline in the rat isolated aorta. Eur J Pharmacol 123:279–285
Herrmann WM (1993) Global benefits of drug treatment in a population of MID patients. Abstract in Progress in the management of age associated memory decline and dementia, Berlin, Germany, September 5
Herrmann WM, Kern U, Röhmel J (1986) On the effects of pyritinol on functional deficits of patients with organic mental disorders. Pharmacopsychiatry 19:378–385
Herrschaft H (1992) Nicergolin. In: Riederer P, Laux G, Pöldinger W (eds) Neuro-Psychopharmaka, Bd 5. Springer, Wien, S 313–324
Honigfeld G (1974) NOSIE-30: history and current status of its use in pharmacopsychiatric research. In: Pichot P (ed) Modern problems of pharmacopsychiatry, Vol 7, Psychological measurements in psychopharmacology. Karger, Basel, pp 238–263
Iliff LD, Du Boulay GH, Marshall JR, Ross RW, Symon L (1979) Wirkung von Nicergolin auf die Gehirndurchblutung. Arzneimittelforschung 29:1277–1278
Italian Cooperative Group (1985) Attivita della nicergolina nel deterioramento cerebrale senile: ricerche cliniche controlate verso placebo. Giorn Geront (Suppl) 62:27–43
Itil TM, Shapiro DM, Eralp E, Akmann A, Itil KZ, Garbizu C (1985) A new brain function diagnostic unit, including the dynamic brain mapping of computer analyzed EEG, evoked potentials and sleep (a new hardware/software system and its application in psychiatry and psychopharmacology). New Trends Clin Psychiatry 1:107–177
Jori MC, De Paolis C, Battaglia A, Ardia A, Praga C (1985) Studio controllato multinazionale: nicergolina nel trattamento sintomatologico dell'invecchiamento cerebrale patologico. Giron Geront 33:1185
Kugler J (1988) Electroencephalographic and psychometric measurements during treatment of cerebral insufficiency with nicergoline and co-dergocrine mesylate. In: Kugler J, Agnoli A (eds) Ergot alkaloids and aging brain: an update on nicergoline. Proceedings of an international symposium. Excerpta Medica, Rome, October 1987
Lagarde M, Guichardant M, Ghazi I, Dechavanne M (1980) Nicergoline, an anti-aggregating agent which inhibits release of arachnidonic acid from human platelet phospholipids. Prostaglandins 19:551–557
Le Poncin-Lafitte M, Grosdemouge C, Duterte D, Rapin JR (1984) Simultaneous study of haemodynamic, metabolic and behavioural sequelae in a model of cerebral ischaemia in aged rats: effects of nicergoline. Gerontology 30:109–119
Maiolo AT, Bianchi Porro G, Galli C, Sessma M (1972) Effects de la nicergoline sur l'hemodynamique cerebrale et la metabolisme ceerebral dans l'hypertension arterielle essentielle et l'arteriosclerose. Clin Ther 62:239–252
Martucci N, Manna V, Battaglia A (1985) Eine placebokontrollierte Studie mit Nicergolin an Patienten mit organischem Hirnsyndrom, die an kochleären und vestibulären Störungen leiden. In: Heidrich H (ed) Therapeutische Wirksamkeitsnachweise bei nootropen und vasoaktiven Substanzen. Springer, Berlin, Heidelberg, New York, Tokyo, S 57–66
McArthur RA, Cervini MA, Carfagna N (1993) Nicergoline reverses the learning deficits in the radial maze of aged rats. Presented at the 1993 Summer Meeting of the British Association for Psychopharmacology, 25–28 July, Cambridge. Psychopharmacology, Suppl.: A16
Meese W, Kluge W, Grumme T, Hopfenmüller W (1980) CT evaluation of the CSF spaces of healthy persons. Neuroradiology 19:131–136
Moglia A, Arrigo A (1989) Ergot derivatives in the aging brain correlation between EEG spectral analysis and clinical findings. Funct Neurol 4:23–26
Moglia A, Arrigo A, Battaglia A, Sacchetti C (1985) Korrelation zwischen computerausgewertetem EEG und klinischen Befunden bei Patienten mit seniler Demenz. In: Heidrich H (ed) Therapeutische Wirksamkeitsnachweise bei nootropen und vasoaktiven Substanzen. Springer, Berlin, Heidelberg, New York, Tokyo, S 49–54
Moretti A, Carfagna N, Caccia C, Carpentieri M, Amico A, Marchi G, Trunzo F (1985) Neurochemical effects of ergoline derivatives. In: Heidrich H (ed) Proof of therapeutic effectiveness of nootropic and vasoactive drugs. Springer, Berlin, Heidelberg, New York, Tokyo, pp 103–110
Moretti A, Carfagna N, Caccia C, Carpentieri M (1988) Effects of ergolines on neurotransmitter systems in the rat brain. Arch Int Pharmacodyn 294:33–45
Nicergoline Cooperative Study Group (1990) A double-blind randomized study of two ergot derivatives in mild to moderate dementia. Curr Ther Res 48:597–612
Paul A, Chandra P (1979) Einfluß von Nicergolin auf molekularbiologische Prozesse im Gehirn und seine Auswirkung auf die Lernfähigkeit der Ratte. Arzneimittelforschung 29:1238–1251
Pogliani E, Della Volpe A, Ferrari R, Recalcati P, Praga C (1975) Inhibition of human platelet aggregation by oral administration of nicergoline. A double-blind study. Il Farmaco (Prat) 30:630–640
Polich J (1991) P300 in the evaluation of aging and dementia. In: Brunia CHM, Mulder G, Verbaten MN (eds) Event-related brain research. Elsevier, Amsterdam, pp 304–323
Rossi AC, Carfagna N, Caccia C, Carpentieri M, Moretti A (1988) Neurochemical effects of ergoline derivatives. In: Kugler J, Agnoli A (eds) Ergot alkaloids and aging brain an update on nicergoline. Proceedings of an international symposium. Excerpta Medica, Rome, October 1987, pp 16–24
Rossi A, Battaglia A, Novellini R, Buonamici M, Carfagna N, Orlando N, Pamparana F (1990) Nicergoline: pharmacological properties and clinical studies in aging brain. In: Alan R (ed) Aging brain and dementia: new trends in diagnosis and therapy. Liss, New York, pp 549–576
Saletu B (1981) Application of quantitative EEG in measuring encephalotropic and pharmacodynamic properties of antihypoxidotic/nootropic drugs. In: Scientific International Research (ed) Drugs and Methods in C.V.D. Proc Int Cerebrovascular Diseases. Pergamon Press, France, pp 79–115
Saletu B (1991) Co-dergocrine type drugs in the pharmacotherapy of mental and cognitive disorders in aging. In: Racagni G, Brunello N, Fukuda T (eds) Biological psychiatry Volume 2. Excerpta Medica, Amsterdam, London, New York, Tokyo, pp 163–165
Saletu B (1993) Neurophysiological assessment of efficacy in drug trials with memory disorders. In: Canal N, Hachinski VC, McKhann G, Franceschi M (eds) Guidelines for drug trials in memory disorders. Raven Press, New York, pp 303–331
Saletu B (1994) EEG/EP mapping in neurodegenerative and cognitive disorders. In: Racagni G (ed) Recent advances in the treatment of neurodegenerative disorders and cognitive dysfunction. Int Acad Biomed Drug Res, Vol 7, Karger, Basel, Freiburg, Paris, London, New York, New Delhi, Bangkok, Singapore, Tokyo, Sydney, pp 24–30
Saletu B, Grünberger J (1980) Antihypoxidotic and nootropic drugs: Proof of their encephalotropic and pharmacodynamic properties by quantitative EEG investigations. Prog Neuro Psychopharmacol 4:469–489
Saletu B, Grünberger J (1985) Memory dysfunction and vigilance: neurophysiological and psychopharmacological aspects. Ann N Y Acad Sci 444:406–427
Saletu B, Grünberger J, Linzmayer L (1979a) Bestimmung der encephalotropen, psychotropen und pharmakodynamischen Eigenschaften von Nicergolin mittels quantitativer Pharmakoelektroenzephalographie und psychometrischer Analysen. Arzneimittelforschung 29:1251–1261
Saletu B, Grünberger J, Linzmayer L, Anderer P (1979b) Proof of CNS efficacy and pharmacodynamics of nicergoline in the elderly by acute and chronic quantitative pharmaco-EEG and psychometric studies. In: Tognoni G, Garattini S (eds) Drug treatment in chronic cerebrovascular disorders. Elsevier/North Holland, Biomedical Press, Amsterdam, pp 245–272
Saletu B, Anderer P, Kinsperger K, Grünberger J (1987) Topographic brain mapping of EEG in neuropsychopharmacology — part II. Clinical applications (Pharmaco EEG imaging). Meth Find Exp Clin Pharmacol 9 [6]:385–408
Saletu B, Anderer P, Paulus E, Grünberger J, Wicke L, Neuhold A, Fischhof PK, Litschauer G, Wagner G, Hatzinger R, Dittrich R (1988) EEG brain mapping in SDAT and MID patients before and during placebo and xantinolnicotinate therapy: reference considerations. In: Samson-Dollfus D, Guieu JD, Gotman J, Etevenon P (eds) Statistics and topography in quantitative EEG. Elsevier, Paris, pp 251–275
Saletu B, Grünberger J, Anderer P (1990a) Pharmaco-EEG and brain mapping in cognitive enhancing drugs. Clin Neuropharmacol 13 [Suppl. 2]:575–576
Saletu B, Anderer P, Grünberger J (1990b) Topographic brain mapping of EEG after acute application of ergotalkaloids in the elderly. Arch Gerontol Geriatr 11:1–22
Saletu B, Grünberger J, Anderer P (1990c) On brain protection of co-dergocrine mesylate (HydergineR) against hypoxic hypoxidosis of different severity: double-blind placebo-controlled quantitative EEG and psychometric studies. Int J Clin Pharmacol Ther Toxicol 28:510–524
Saletu B, Grünberger J, Linzmayer L, Anderer P (1990d) Brain protection of nicergoline against hypoxia: EEG brain mapping and psychometry. J Neural Transm Park Dis Dement Sect 2:305–325
Saletu B, Anderer P, Paulus E, Grünberger J, Wicke L, Neuhold A, Fischhof KP, Litschauer G (1991a) EEG brain mapping in diagnostic and therapeutic assessment of dementia. Alzheimer Dis Assoc Disord 5, [Suppl. 1]:57–75
Saletu B, Anderer P, Grünberger J, Paulus E, Fischhof PK, Wicke L, Neuhold A (1991b) On diagnosis, differential diagnosis and pharmacotherapy of dementia; mapping of EEG and its correlations to clinical variables. In: Racagni G, Brunello N, Fukuda T (eds) Biological psychiatry Volume 2. Excerpta Medica, Amsterdam, London, New York, Tokyo, pp 398–400
Saletu B, Anderer P, Fischhof PK, Lorenz H, Barousch R, Böhmer F (1992) EEG mapping and psychopharmacological studies with denbufylline in SDAT and MID. Biol Psychiatry 32:668–681
Semlitsch H, Anderer P, Saletu B, Resch F, Presslich O, Schuster P (1989) Psychophysiological research in psychiatry and neuropharmacology. I. Methodological aspects of the Viennese Psychophysiological Test-System (VPTS). Meth Find Exp Clin Pharmacol 11:25–41
Semlitsch HV, Anderer P, Saletu B, Hochmayer I (1990) Topographic mapping of cognitive event-related potentials in a double-blind, placebo-controlled study with the hemoderivative actovegin in age-associated memory impairment. Neuropsychobiology 24:49–56
Semlitsch HV, Anderer P, Saletu B (1992) Topographic mapping of long latency “cognitive” event-related potentials (P300): a double-blind, placebo-controlled study with amantadine in mild dementia. J Neural Transm [P-D Sect] 4:319–336
Shader RI, Harmatz JS, Salzman C (1974) A new scale for clinical assessement in geriatric populations: Sandoz Clinical Assessment Geriatric (SCAG). J Am Geriatr Soc 22:107–113
Shintomi K, Egon H, Tanaka T, Itakura T, Yoshimoto K, Matsamoto M, Matsuoka Y (1986) Pharmacological study of nicergoline (I). Protective effect against anoxic brain damages in animals. Folia Pharmacol Jpn 87:445–456
Squires KC, Chippendale TJ, Wrege KS, Goodin DS, Starr A (1980) Electrophysiological assessment of mental function in aging and dementia. In: Poon LW (ed) Aging in the 1980s: selected contemporary issues in the psychology of aging. American Psychological Association, Washington, DC, pp 125–134
Zappoli R, Versari A, Paganini M, Arnetoli G, Battaglia A, Ardia A, Maniero A (1988) Effect of long-term nicergoline treatment on contingent negative variation activity and clinical status of patients with presenile idiopathic mental deterioration: preliminary findings. In: Kugler J, Agnoli A (eds) Ergot alkaloids and aging brain an update on nicergoline. Proceedings of an international symposium. Excerpta Medica, Rome, October 1987, pp 72–83
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Saletu, B., Paulus, E., Linzmayer, L. et al. Nicergoline in senile dementia of alzheimer type and multi-infarct dementia: a double-blind, placebo-controlled, clinical and EEG/ERP mapping study. Psychopharmacology 117, 385–395 (1995). https://doi.org/10.1007/BF02246209
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02246209