Piracetam is the first of the so-called '
nootropic' drugs, a unique class of drugs which affect mental function. In animal models and in healthy volunteers, the
drug improves the efficiency of the higher telencephalic functions of the brain involved in cognitive processes such as learning and memory. The pharmacology of
piracetam is unusual because it protects against various physical and chemical insults applied to the brain. It facilitates learning and memory in healthy animals and in animals whose brain function has been compromised, and it enhances interhemispheric transfer of information via callosal transmission. At the same time, even in relatively high dosages it is devoid of any
sedative,
analeptic or autonomic activities. How
piracetam exerts its effects on
memory disorders is still under investigation, although among other proposed mechanisms of action it is thought to facilitate central nervous system efficiency of
cholinergic neurotransmission. Results from trials involving elderly patients with senile
cognitive disorders have been equivocal, as have the results obtained when
piracetam has been combined with
acetylcholine precursors.
Piracetam seems to be almost completely devoid of adverse effects, and is extremely well tolerated. In conclusion, opinion is divided as to the benefits of
piracetam in the treatment of senile
cognitive decline. Although double-blind studies in the elderly have produced mixed results, some such trials (particularly those involving larger numbers of patients) have reported favourable findings, thus offering some reason for cautious optimism in a notoriously difficult area of
therapeutics. However, further investigations of
piracetam alone and in combination
therapy are required before any absolute conclusions can be drawn.