Co-dergocrine

Findings:

Significant associations with moderate effect sizes were found between both grey matter and white matter indices and cognitive functioning in adults with BD, though with substantial heterogeneity. Bipolar subtype, current mood state, and cognitive domain moderated these relationships, while age, sex, psychosis, and mania did not. Brain networks may provide a broad integrative framework for these associations.

Participants:

Adults with Bipolar Disorder (BD), diagnosed according to standard criteria.

Study Quality Assessment:

Systematic review and meta-analysis examining 80 studies (50 met criteria for meta-analysis). Methods included structural and diffusion-weighted MRI, and standardized cognitive assessments. Substantial heterogeneity noted in findings. Funding source mentioned (CIHR Postdoctoral Fellowship to BDMJ).

All Effects:

Authors:

Jason T Olin, Lon Schneider

Findings:

This systematic review found that Hydergine showed statistically significant treatment effects compared to placebo when assessed by global ratings (OR 3.78) and comprehensive rating scales (WMD 0.96) in patients with possible dementia or age-related cognitive symptoms. However, uncertainty remains regarding its efficacy specifically in dementia syndromes like Alzheimer's disease, largely due to methodological limitations (e.g., less specific diagnostic criteria) in the older trials reviewed. Subgroup analyses suggested possible greater benefit in younger subjects and at higher doses (4.5-9.0 mg/day), but these findings were often not statistically significant.

Participants:

Elderly patients with possible dementia, or 'age‐related' cognitive symptoms, including diagnostic syndromes consistent with dementia (e.g., possible Alzheimer's disease (AD), possible vascular dementia, primary dementia, cerebral insufficiency, cerebral deterioration). Nineteen trials included, with participant numbers ranging from 19 to 458. Subgroup analyses considered age (65-75 vs 76-85 years) and inpatient/outpatient status.

Dosage:

Trials reviewed tested various oral doses, including 1.5mg, 3mg, 4.5mg, 6mg, and 7.5mg per day, sometimes administered multiple times daily (e.g., t.i.d.) or once daily. Some trials used variable doses. Subgroup analyses compared low (1.5-3.0mg/d) vs high (4.0-9.0mg/d) doses, suggesting potentially greater effects at higher doses (4.5-9.0 mg/day), possibly higher than the 3 mg/d approved in the USA at the time.

Study Quality Assessment:

Systematic review (Cochrane Database Syst Rev) of randomized, double-blind, parallel-group, placebo-controlled trials (N=19) with treatment duration > 1 week. Searched multiple databases (Cochrane, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, registries, grey literature) up to March 2009. Data extracted independently by reviewers and pooled using standard methods (Odds Ratios, Weighted Mean Differences). Quality assessed using Cochrane guidelines (allocation concealment). Limitations noted: many included trials were old (pre-1984), used less specific diagnostic criteria, had small sample sizes, potential publication bias, and often lacked intention-to-treat analysis in publications (though reviewers used ITT where possible). Heterogeneity was observed in analyses.

All Effects:

Participants:

41 outpatients aged 55 to 80 years with mild memory impairment

Study Quality Assessment:

double-blind study, N=41

Authors:

Wadworth AN...

Findings:

Co-dergocrine mesylate improves cognitive indices like memory and learning in animal models and healthy elderly volunteers, potentially via effects on monoaminergic systems, EEG frequencies, and cerebral metabolism. While controlled studies in elderly patients with cognitive decline showed it was well tolerated and sometimes had statistically significant positive effects, the clinical relevance is controversial due to methodological variability and diagnostic overlap. Its specific therapeutic place remains undetermined.

Participants:

Animal models, healthy elderly volunteers, elderly patients with age-related cognitive decline.

Study Quality Assessment:

Review of controlled studies. Limitations mentioned: wide variability in cognitive/neuropsychological assessments used, potential overlap in patient diagnosis (varying degrees of dementia), lack of comparison with more recently developed agents.

All Effects: