An Ergot Alkaloid Preparation (Hydergine) in the Treatment of Dementia: Critical Review of the Clinical Literature

Abstract

A critical review is presented of 12 clinical trials with Hydergine (a hydrogenated ergot alkaloid preparation) in the treatment of dementia. Qualitative and quantitative comparisons of improvement in symptoms showed that Hydergine consistently produced statistically significant (p less than or equal to 0.05) improvement in 13 symptoms associated with dementia. However, because of the small magnitude of the improvement and the absence of indications of long-term benefit, Hydergine would seem to be of minor value in dementia therapy. Further research with better methodology and design might lead to a different conclusion.

Co-Dergocrine Mesylate

“…Reports as early as 1956 demonstrated that therapy with co-dergocrine mesylate had a greater positive effect on symptoms of age-related cognitive decline than placebo (Hofstatter et al 1956) and previous reviews of controlled studies using standardised rating scales have shown that co-dergocrine mesylate therapy (1 or 1.5mg 3 times daily in most studies) was associated with consistent and statistically significant improvements in symptoms of cognitive decline such as mental dullness, disorientation, confusion, recent memory loss and mood depression (Hughes et al 1976;McDonald 1979). Reports as early as 1956 demonstrated that therapy with co-dergocrine mesylate had a greater positive effect on symptoms of age-related cognitive decline than placebo (Hofstatter et al 1956) and previous reviews of controlled studies using standardised rating scales have shown that co-dergocrine mesylate therapy (1 or 1.5mg 3 times daily in most studies) was associated with consistent and statistically significant improvements in symptoms of cognitive decline such as mental dullness, disorientation, confusion, recent memory loss and mood depression (Hughes et al 1976;McDonald 1979).…”

“…In the past 2 decades there has been considerable debate regarding the clinical usefulness of codergocrine mesylate in such indications (see reviews by Hughes et al 1976;McDonald 1979;Yesavage et al 1979) despite demonstration of small but consistently statistically significant improvements in patients with age-related cognitive decline. More recent studies, such as one which demonstrated that co-dergocrine mesylate had no beneficial effects in patients with Alzheimer's disease (Thompson et al 1990) and which generated considerable comment on the relevance of the chosen study design and data analysis, have done little to resolve this controversy, despite their use of standardised assessment scales and their longer treatment duration.…”

Handbook of Psychopharmacology

“…Original investigations published subsequent to these reviews have provided no data that would call for substantial modification of their conclusions regarding efficacy. Hughes et al (1976) reviewed 12 studies of the efficacy of Hydergine. No studies attempted to separate demented patients by diagnosis, and several lacked double-blind procedures; some found small improvement due to Hydergine on clinical ratings, but no improvements were observed on cognitive tests.…”

Hydergine in Senile Mental Impairment

“…A critical review of the results available at the time [Hughes et al, 1976], while recog nizing the significant improvements brought about by Hydergine in 13 clinical variables of the SCAG scale, pointed out that the im provement and the responder rate were nev ertheless relatively modest: 47% of patients had been improved by 1 point or more in the 7-point rating range, and 38% by 2 points or more. Thus, the necessity for improved methodology and more extensive studies be came obvious.…”