No abstract

Montelukast is a well-established antiasthmatic drug with little side effects. It is a leukotriene receptor antagonist and recent research suggests cognitive benefits from its anti-inflammatory actions on the central nervous system. However, changes in brain activity were not directly shown so far in humans. This study aims to document changes in brain activity that are associated with cognitive improvement during treatment with Montelukast. We recorded EEG and conducted neuropsychological tests in 12 asthma-patients aged 38–73 years before and after 8 weeks of treatment with Montelukast. We found no significant changes on neuropsychological scales for memory, attention, and mood. In the EEG, we found decreased entropy at follow up during rest (p < 0.005). During episodic memory acquisition we found decreased entropy (p < 0.01) and acceleration of the background rhythm (p < 0.05). During visual attention performance, we detected an increase in gamma power (p < 0.005) and slowing of the background rhythm (p < 0.05). The study is limited by its small sample size, young age and absence of baseline cognitive impairment of the participants. Unspecific changes in brain activity were not accompanied by cognitive improvement. Future studies should examine elderly patients with cognitive impairment in a double-blind study with longer-term treatment by Montelukast.

This example of an 80-year-old patient with severe lung disease and respiratory failure demonstrates the difficult relationship between the patient's needs, physical symptoms, and social problems. This man decides after a prolonged and difficult in-patient treatment actively for home ventilation rather than die of respiratory failure. He opts for tracheostomy and invasive ventilation because he cannot handle non-invasive mask-ventilation sufficiently by himself. It requires professional communication and support to gain the acceptance of family and caregivers for home ventilation. A survey of existing data on end of life decision-making in end-stage lung disease is given.