Piracetam prevents cognitive decline in coronary artery bypass: a randomized trial versus placebo.

BACKGROUND: Coronary artery bypass grafting (CABG) can be associated with postoperative cognitive impairment and ischemic stroke. No effective treatment is currently available. The aim of this study was to evaluate the effectiveness of piracetam to treat the cognitive impairment after CABG in an investigator-initiated, double-blind, placebo-controlled, randomized clinical trial. METHODS: Patients undergoing CABG (n = 98) were randomized to placebo (n = 48) or piracetam (n = 50). Study drugs were administered intravenously (150 mg/kg daily; 300 mg/kg on the day of surgery) from the day before surgery to 6 days after surgery, then orally (12 g/day) up to 6 weeks after surgery. Cognitive function was assessed before surgery (baseline) and 6 weeks after surgery (outcome) by using a battery of 12 neuropsychologic tests. The Spielberger Anxiety Inventory and the Beck Depression Inventory were also administered. The combined score derived from the standardized neuropsychologic assessments was analyzed by using an analysis of covariance with baseline and education as covariates. RESULTS: Six weeks after surgery, the combined score indicated a statistically significant treatment effect in the per protocol population (1.848, p = 0.041) and a tendency towards statistical significance in the intent-to-treat population (1.624, p = 0.064) in the group treated with piracetam, but no statistically significant treatment effect was seen in the placebo. The state of anxiety measured by the Spielberger Anxiety Inventory was decreased in both groups (-9.27 and -6.37 in the placebo and piracetam groups, respectively). CONCLUSIONS: Six weeks after CABG, cognition was significantly improved in patients treated with piracetam. Additional trials are required to confirm these effects.

[Comparison of clinical data of two autopsy series, 1938-1951 and 1990-2002, at the Debrecen University Department of Neurology]. / A klinikai paraméterek változásai 1938-1951 es 1990-2002 között, a Debreceni Idegklinika agyboncolási adatainak elemzése alapján.

BACKGROUND: The clinical parameters of autopsied brains in two periods (1938-1951 and 1990-2002) were analyzed and compared. METHODS: Gender distribution, age, clinical diagnosis, treatment length of 695 (1938-1951) and 1378 (1990-2002) autopsies of Department of Neurology, Debrecen, Hungary were investigated. RESULT: Between 1938-1951 mean 49.6 +/- 15.5 autopsies/year were performed while in the 1990-2002 the autopsies raised to 106 +/- 19.6 /year. In the first period almost all deceased patient has been autopsied, but the ratio decreased on 68.9% between 1990-2002. The average age of autopsied patients (39.1 +/- 2.9 years) almost doubled after 40 years (69.5 +/- 2.0 years). In the first period (1938-1951) the infectious and tumorous cases were most frequent (33.6% and 31.2%), while in the second one, the cerebrovascular diseases dominated (84.5%). There was no significant difference between the treatment lengths of two periods (18.1 and 14.5 days, respectively). CONCLUSIONS: While the absolute number of autopsies raised after 40 years, the ratio decreased at our department (from 100% to 68.9%), similarly to the worldwide trends. The significantly higher age of autopsied patients and the different spectrum of clinical diagnosis reflects the decrease of infectious diseases and increase of stroke frequency and the ageing of the Hungarian population. Authors sustain with literary data that autopsy should not be ignored, and are convinced, together with professor Mohr, that "autopsy is the ultimate audit of medicine, the yardstick of clinical care and research. To dispence with autopsy is an unfortunate trend that certainly endangers the value of clinical research."