Bromocriptine and speech therapy in non-fluent chronic aphasia after stroke

Bragoni, Maura; Altieri, Marta; Piero, Vittorio Di; Padovani, Alessandro; Mostardini, C; Lenzi, Gian Luigi

doi:10.1007/s100720070114

Cited by 72 publications

(40 citation statements)

References 10 publications

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“…A more promising strategy may be the repeated administration of dopamine agonists in conjunction with associative training over several days. There is preliminary evidence from several uncontrolled trials with stroke patients that verbal fluency can be improved in nonfluent aphasics after several weeks of bromocriptine administration in combination with language training (Bragoni et al, 2000;Gold et al, 2000;Gupta and Mlcoch, 1992;Sabe et al, 1992). This positive trend could not be replicated in two randomized clinical trials on bromocriptine (Gupta et al, 1995;Sabe et al, 1995).…”

Section: Introductionmentioning

confidence: 98%

Tonic Dopaminergic Stimulation Impairs Associative Learning in Healthy Subjects

Breitenstein

Korsukewitz

Flöel

et al. 2006

Neuropsychopharmacol

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Endogenous dopamine plays a central role in salience coding during associative learning. Administration of the dopamine precursor levodopa enhances learning in healthy subjects and stroke patients. Because levodopa increases both phasic and tonic dopaminergic neurotransmission, the critical mechanism mediating the enhancement of learning is unresolved. We here probed how selective tonic dopaminergic stimulation affects associative learning. Forty healthy subjects were trained in a novel vocabulary of 45 concrete nouns over the course of 5 consecutive training days in a prospective, randomized, double-blind, placebo-controlled design. Subjects received the tonically stimulating dopamine-receptor agonist pergolide (0.1 mg) vs placebo 120 min before training on each training day. The dopamine agonist significantly impaired novel word learning compared to placebo. This learning decrement persisted up to the last follow-up 4 weeks post-training. Subjects treated with pergolide also showed restricted emotional responses compared to the PLACEBO group. The extent of 'flattened' affect with pergolide was related to the degree of learning inhibition. These findings suggest that tonic occupation of dopamine receptors impairs learning by competition with phasic dopamine signals. Thus, phasic signaling seems to be the critical mechanism by which dopamine enhances associative learning in healthy subjects and stroke patients.

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Section: Introductionmentioning

confidence: 98%

Tonic Dopaminergic Stimulation Impairs Associative Learning in Healthy Subjects

Breitenstein

Korsukewitz

Flöel

et al. 2006

Neuropsychopharmacol

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“…In a study of 25 nonfluent aphasic patients randomized to receive bromocriptine combined with speech therapy or placebo in an 18-week, double-blind study, improvement in dictation, reading comprehension, repetition, and verbal latency was observed. 3 The improvement in repetition observed seem to be very small and improvement observed in dictation seems to be related to speech therapy per se.…”

Section: Results Thirty-eight Patients (20 [526%] Men 18mentioning

confidence: 95%

“…[1][2][3][4][5][6][7][8][9] In a 62-year-old man with transcortical motor aphasia 3.5 years after his stroke, low doses (15 mg/day) of bromocriptine produced slight improvements in confrontation naming and the responsive naming and reductions in the number and proportion of pauses recorded in conversation. 5 At the higher dose (30 mg/day), the improvements were less obvious.…”

Section: Results Thirty-eight Patients (20 [526%] Men 18mentioning

confidence: 99%

“…However, the effect of bromocriptine on nonfluent aphasia in stroke patients is not clear. [1][2][3][4][5][6][7][8][9] Some trials showed no effect 1,2,4 and others showed a positive effect, 3,5-9 but these studies were mostly small openlabel studies. Therefore, we conducted a large doubleblind study to determine whether bromocriptine can be used in the clinical setting for the management of nonfluent aphasia after stroke.…”

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confidence: 99%

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Transient prosopagnosia after ischemic stroke

Lang

Baudewig²,

Kallenberg³

et al. 2006

Neurology

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Abstract-The authors assessed the efficacy of bromocriptine in nonfluent aphasia after stroke in a 16-week, randomized, double-blind, placebo-controlled clinical trial conducted from June 2002 to April 2004. In all 38 patients after 4 months of treatment, improvement in both the bromocriptine and placebo treatment groups was observed (p Ͻ 0.001). The analysis of repeated-measures analysis of variance revealed bromocriptine did not improve nonfluent aphasia. NEUROLOGY 2006;66:914-916 F. Ashtary, MD; M. Janghorbani, PhD; A. Chitsaz, MD; M. Reisi, MD; and A. Bahrami, BS Bromocriptine mesylate, an ergot derivative, is a sympatholytic dopamine D 2 receptor agonist that exerts inhibitory effects on serotonin turnover in the CNS. In partial lesions, such as those associated with nonfluent aphasia, postsynaptic dopaminergic agents, such as bromocriptine, could improve frontal lobe function. However, the effect of bromocriptine on nonfluent aphasia in stroke patients is not clear. [1][2][3][4][5][6][7][8][9] Some trials showed no effect 1,2,4 and others showed a positive effect, 3,5-9 but these studies were mostly small openlabel studies. Therefore, we conducted a large doubleblind study to determine whether bromocriptine can be used in the clinical setting for the management of nonfluent aphasia after stroke.Methods. Thirty-eight nonfluent aphasic stroke patients in an acute phase were recruited from the neurology emergency department of Isfahan University of Medical Sciences Hospitals, Isfahan, Iran, between June 2002 and April 2004. Entry criteria included age 80 years and younger, right-handedness, Persian speaking, and availability for follow-up for 4 months. All patients had no evidence of cardiac, hepatic, renal, or other chronic or neuropsychiatric disorder, as determined by history, physical examination, and screening laboratory tests. Neurologic examination, language assessment, routine blood tests, EKG, and brain CT or MRI were performed before study entry. The nature of the trial was explained to the patient or their first-degree relatives and his or her written consent obtained. Tenets of current version of the Declaration of Helsinki were followed, and institutional ethical committee approval was granted.The 38 participants were assigned randomly and equally to one of the two treatment groups by flipping a coin at the time of study entry. The first treatment group received bromocriptine in a 2.5-mg/day increment over 4 weeks to 10 mg/day for a total of 4 months. The second group received a placebo. The placebo was identical in appearance and packaging to the active drug. The dose of bromocriptine or matching placebo remained constant during the following 16 weeks of the study. All patients tolerated the dose-escalation protocol without major side effects. Therefore, no participants were excluded from the study.The trial was double blinded in that both patient and speech therapist were not aware of treatment type that the patient was received. Patients were evaluated at 0, 8, and 16 weeks after the start ...

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“…Preliminary reports suggest that pharmacologic facilitation of brain injury rehabilitation may improve cognitive outcomes (Berthier et al, 2009;Bragoni et al, 2000); however, few studies examine the efficacy of pharmacologically facilitated cognitive rehabilitation, and none have focused specifically on this approach to the treatment of cognitive impairments in the late period following TBI. This study implemented a double-blind, placebo-controlled trial of the effectiveness of two forms of cognitive rehabilitation (remediation and compensatory training) and MPH, alone and in combination, to treat cognitive symptoms after TBI.…”

Section: Introductionmentioning

confidence: 99%

Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial

McDonald

Flashman

Arciniegas

et al. 2016

Neuropsychopharmacol

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The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacologic enhancement (i.e., with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least four months prior to study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding

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Bromocriptine and speech therapy in non-fluent chronic aphasia after stroke

Cited by 72 publications

References 10 publications

Tonic Dopaminergic Stimulation Impairs Associative Learning in Healthy Subjects

Tonic Dopaminergic Stimulation Impairs Associative Learning in Healthy Subjects

Transient prosopagnosia after ischemic stroke

Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial

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