Effect of Piracetam on Cognitive Performance in Patients Undergoing Bypass Surgery

In this study, the protective effect of piracetam on select aspects of cognitive function in patients undergoing bypass surgery was investigated.

Male patients (n = 64) with an indication for a surgical revascularization using artificial extracorporal circuits were randomly assigned in a double-blind fashion to receive a single challenge of 12-g piracetam infusion or placebo (sterile saline) prior to the bypass surgery. A brief battery of neuropsychological tests for verbal and non-verbal short-term memory and attention was administered 1 day before and 3 days after the surgical intervention.

There was a significant difference in short-term memory and attention, with the piracetam-treated patients producing a better level of performance 3 days after surgery compared to the placebo group. The overall postoperative cognitive function (z-transformation of all 6 test results) was more significantly (p < 0.001) reduced in the placebo group than in the piracetam group (z = -1.19 ± 0.72 vs. -0.46 ± 0.58, respectively).

A single challenge of 12-g piracetam infusion prior to surgical intervention might offer a short-term neuroprotective effect for patients undergoing cardiac bypass surgery. Whether this effect persists for a longer period of time requires further investigation.

References

• 1 Bick R L. In vivo platelet inhibition by piracetam.  The Lancet. 1979;  8145 752-753
• 2 Brown P, Steigert M J, Thompson P D, Day J C, Salama M, Waegemans T, Marsden C D. Effectiveness of piracetam in cortical myoclonus.  Movement Disord. 1993;  8 63-68
• 3 Cheng D C, Karski J, Peniston C, Asokumar B, Raveendran G, Carroll J . et al . Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: a prospective randomized controlled trial.  J Thorac Cardiovasc Surg. 1996;  112 755-764
• 4 Christoffersen G RJ, von Linstow-Roloff E, Sandager-Nielsen K. Effect of piracetam on the performance of rats in a delayed match-to-position task.  Prog Neuro-Psychopharmacol & Biol Psychiat. 1998;  22 11-228
• 5 Coq J O, Xerri C. Acute reorganization of the forepaw representation in the rat SI cortex after focal cortical injury: neuroprotective effects of piracetam treatment.  Eur J Neurosci.. 1999;  11 2597-2608
• 6 De Deyn P P, Reuck J D, Deberdt W, Vlietinck R, Orgogozo J M. Treatment of acute ischemic stroke with piracetam. Members of the piracetam in Acute Stroke Study (PASS) Group.  Stroke. 1997;  28 2347-2352
• 7 Diegler A, Hirsch R, Schneider F, Scilling L -O, Falk V, Rauch T h, Mohr F W. Neuromonitoring and neurocognitive outcome in off-pump versus conventional coronary bypass operation.  Ann Thorac Surg. 2000;  69 1162-1166
• 8 Dupont J, Tavernier B, Ghosez Y, Durinck L, Thevenot A, Moktadir-Chalons N. et al . Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and isoflurane.  Br J Anaesth. 1999;  82 355-359
• 9 Erzigkeit H. SKT. Ein Kurztest zur Erfassung von Gedächtnis- und Aufmerksamkeitsstörungen. Beltz Test GmbH Weinheim; 1989
• 10 Grieco G, d’Hollosy M, Culliford A t, Jonas S. Evaluating neuroprotective agents for clinical anti-ischemic benefits using neuropsychological changes after cardiac surgery under cardiopulmonary bypass. Methodological strategies and results of a double-blind, placebo-controlled trial of GM1 ganglioside.  Stroke. 1996;  27 858-874
• 11 Gallinat J, Möller H -J, Hegerl U. Piracetam in der Anästhesie zur Prophylaxe eines postoperativen Delirs.  Anästhesiol Intensivmed Notfallmed Schmerzther. 1999;  34 1-8
• 12 Grotemeyer K H, Hoffeberth B, Hirschberg M. Normalisierung hyperreaktiver Thrombozyten bei Patienten mit TIAŽs unter Piracetam.  Nervenarzt. 1986;  57 180-183
• 13 Kanowski S. Piracetam In: Riederer, Laux, Pöldinger (Hrsg) Neuropsychopharmaka Bd 5. Springer Verlag Wien; 1999: pp 189-204
• 14 Kim Y S, Nibbelink D W, Overall J E. Factor structure and scoring of the SKT test battery.  J Clin Psychollogy. 1993;  49 61-71
• 15 Lagergren K, Levander S. A double-blind study on the effects of piracetam upon perceptual and psychomotoric performance at varied heart rates in patients treated with artificial pacemakers.  Psycgho pharmacologia. 1974;  39 97-104
• 16 Means L W, Comer T R, Moore R. BMY 21 502 and piracetam facilitate performance of two-choice water-escape in normal rats.  J Neural Transm. 1991;  85 109-116
• 17 Moriau M, Crasborn L, Lavenne-Pardonge E, von Frenckell R, Col-Debeys C h. Platelet anti-aggregant and rheological properties of piracetam.  Drug Res. 1993;  43 110-118
• 18 Murkin J M, Newman S P, Stump D A, Blumenthal J. Statement of consensus on assessment of neurobehavioral outcomes after cardiac surgery.  Ann Thorac Surg. 1995;  59 1289-1295
• 19 Müller W E, Eckert G P, Eckert A. Piracetam: Novelty in a unique mode of action.  Pharmacopsychiatry. 1999;  32 Suppl, 12-19
• 20 Newman M F, Kirchner J L, Philips-Bute B, Gaver V, Grocott H, Jones R. et al . Longitudinal assessment of neurocognitive function after coronary artery bypass surgery.  N Eng J Med. 2001;  344 395-402
• 21 Pfitzenmeyer P, Musat A, Lenfant L, Turcu A, Musat A. Postoperative cognitive disorders in the elderly.  Presse Med. 2001;  30 648-652
• 22 Peuvot J, Schanck A, Deleers M, Brasseurs R. Piracetam-induced changes to membrane physical properties.  Biochem Pharmacol. 1995;  50 1129-1134
• 23 Saletu B, Hintzenberger G, Grünberge J, Anderer P, Zyhlarz G, Linzmayer L, Rameis H. Double-blind, placebo-controlled, pharmacokinetic and -dynamic studies with 2 new formulations of piracetam (infusion and sirup) under hypoxia in man.  Int J Clin Pharmacol Therapeutics. 1995;  33 49-262
• 24 Sara S L, Lefevre D. Hypoxia-induced amnesia in one-trial learning and pharmacological protection by piracetam.  Psychopharmacologia. 1972;  25 32-40
• 25 Selnes O A, Royall R M, Grega M A, Borowicz L M, Quaskey S, McKhann G M. Cognitive changes 5 years after coronary artery bypass grafting.  Arch Neurol. 2001;  58 598-604
• 26 Shaw P J, Bates D, Cartlidge N E, French J M, Heaviside D, Julian D G, Shaw D A. Early intellectual dysfunction following coronary bypass surgery.  Q J Med. 1986;  58 59-68
• 27 Stockmans F, Deberdt W, Nyström A, Nyström E, Strassen J M, Vermylen J, Deckmyn H. Inhibitory effect of piracetam on platelet-rich thrombus formation in an animal model.  Thromb Haemost. 1998;  79 222-227