Nootropics and procognitive drugs – these are substances that enhance the work of the brain. In the era of rushing time, when we are overwhelmed by the amount of information coming from various sources, more and more requirements are placed on remembering and processing a lot of data. Therefore, we are looking for a way to improve our intellectual and cognitive abilities.
Memory disorders can be associated not only with stress and fatigue, but also with serious diseases. These diseases can result in irreversible changes in memory. In the elderly, memory problems may result from the natural aging processes or reduced ability to concentrate, while disturbing memory disturbances should always prompt a doctor.
The diseases most often associated with impaired memory processes are: Alzheimer’s disease – occurs in every fifth person over 80, dementia in Parkinson’s disease or frontotemporal dementia.
The reasons for the reduced ability to remember may also include endocrine diseases (e.g. hypothyroidism, Addison’s disease, Cushing’s disease, hypopituitarism), heavy metal poisoning, depression, vitamin deficiencies (B1, B12, folic acid), chronic alcohol abuse, infections of the brain structures (related to e.g. HIV virus), multiple sclerosis, cerebral ischemia and post-stroke conditions.
Modern pharmacology provides us with many means that stimulate the work of the brain. One of them is the so-called nootropic drugs (nootropics). They are not a completely separate group of drugs – some of them are used for different indications. They also do not have a specific structure, but the purpose for which they are used is common. These are substances that stimulate the metabolism of the brain (e.g. by improving the transport properties of the cell membrane, increasing glucose utilization, or activating the metabolism of nucleotides, phospholipids and / or proteins). They improve blood flow in the brain and thus provide oxygen and nutrients, preventing blood clots and neuronal damage from ischemia. Nootropics have a neuroprotective effect by affecting the peroxidation of membrane lipids, and also reduce the effects of brain aging. As a result, various functions of the brain are improved, in particular memory, concentration, attention, judgment and orientation.
The main group of drugs used in cognitive disorders are nootropic drugs (nootropics).
Nootropics can be divided into several groups due to their mechanism of action:
- The most famous representative of this group of drugs is piracetam. Its mechanism of action is based on: activation of metabolic processes of nerve cells, increasing their resistance to hypoxia, increasing the synthesis and use of high-energy compounds, as a result of which there is an improvement in the ability to learn, remember and concentrate attention. It also affects the rheological properties of blood by reducing thrombocyte aggregation and vascular resistance, and increasing the elasticity of capillaries and red blood cells, resulting in an improvement in cerebral microcirculation. The indications for the use of piracetam are cognitive disorders in dementia syndromes (except for Alzheimer’s disease), strokes, dizziness of central origin, weakening of the CNS after neurosurgical operations, as well as in children with behavioral disorders and reading difficulties. The following preparations are available on the Polish pharmaceutical market: biotropil, lucetam, memotropil, nootropil
- Medicinal substances that positively affect blood flow in the brain. These include: vinpocetine, nicergoline, ergotamine. Nicergoline medicinal agents (Nicergolin, Nicerin, Sermion, Adavin) base their therapeutic effect on the relaxation of smooth muscles of blood vessels, mainly in the central nervous system, which results in lowering vascular resistance and increasing arterial blood flow. Nicergoline also inhibits platelet aggregation.
The main nootropic mechanisms of vinpocetine (Cavinton, Vinpoton, Vicebrol) are the improvement of cerebral flow, an increase in transport and uptake of glucose in the brain, and an increase in the availability of acetylcholine.
- Pyritinol is a derivative of vitamin B6. It improves the metabolism of nerve cells. It increases the concentration of serotonin and increases the activity of transaminases, decarboxylases and phosphorylases, stimulating the activity of the brain. It has a non-specific anti-inflammatory effect. The clinical effects of the drug appear after a few days of use. The indications for use are: states of nervous exhaustion, after injuries, strokes, as well as memory and hearing disorders, difficulties in concentration.
The group of procognitive drugs includes both completely natural preparations and various synthetic substances.
Procognitive drugs include substances used, among others, in in the treatment of dementia in Alzheimer’s disease. The genesis of this disease is believed to include in the reduction of neurotransmission in the cholinergic system (this is the oldest hypothesis explaining the development of the disease, but not the only one – the amyloid hypothesis is different). Therefore, a group of drugs increasing cholinergic transmission will be relatively effective in the treatment, i.e. acetylcholinesterase inhibitors: donezepil (Cogiton, Donesyn), galantamine (Nivalin), rivastigmine (Exelon, Evertas).
The group of NMDA receptor antagonists turns out to be effective in the fight against degenerative brain diseases in severe and advanced stages of Alzheimer’s disease. The representative of this group and at the same time the only registered preparation is MEMANTYNA (Axura, Ebixa, (Axura, Memolek, Biomentin, Memabix, Polmatine 1%)). It is generally well tolerated.
One should also not forget about a number of herbal preparations that improve: concentration, memory, vitality, cognitive functions, well-being and the quality of life of healthy people. Ginkgo biloba leaf extract, Ginkgo biloba, ginseng. The group of stimulants with nootropic properties also includes theine (green tea), guaranine (guarana) or mateine (yerba-mate).
Vitamins of group B and C, A, E with antioxidant properties may positively influence the processes taking place in the nervous system. What’s more, the complex preparations also contain substances such as lecithin, indicated in states of physical and mental stress, especially in periods of increased intellectual activity and attention disorders.
Treatment of cognitive disorders is aimed at eliminating the negative effects of dementia and restoring normal brain functions.
Choosing the appropriate pharmacotherapy for a patient may be a problem for doctors, as not all available therapeutic agents are safe to use. The search for drugs to treat the cause of dementia is still being sought, but the work is quite complicated as brain processes have complex mechanisms.
- E. Mutschler, G. Geisslinger, H. K. Kroemer, P. Ruth, Mutschler Pharmacology and Toxicology.
- A. Szczeklik, P. Gajewski, Interna Szczeklik.
- Pharmacodynamics, a textbook for Students of Pharmacy