Bromocriptine treatment of nonfluent aphasia

Gupta, Simran; Mlcoch, Anthony G.

doi:10.1016/0003-9993(92)90012-l

Cited by 53 publications

(11 citation statements)

References 10 publications

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“…45 Both patients improved markedly in speech fluency but not in other aspects of language function. The presence of multiple baselines, with lack of improvement in language measures other than fluency, gives this study some weight.…”

Section: Augmentation Of Brain Dopaminementioning

confidence: 92%

Pharmacotherapy of aphasia. A critical review.

Small

1994

Stroke

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Communication problems are a common sequela of cerebrovascular disease and other central nervous system disorders. Behavioral treatment of these disorders aims to harness uninjured parts of the brain to improve the communicative life of the individual. While pharmacotherapy has held promise for the treatment of aphasia for over 50 years, it has not fulfilled this promise. This article reviews both the promise and the disappointment of aphasia pharmacotherapy. Diverse theories of the underlying neurological deficits in aphasia have led to different pharmacologic rationales for therapy. Animal studies have demonstrated decreased levels of brain catecholamines after cortical stroke and more rapid stroke recovery with therapy aimed at augmenting brain norepinephrine and dopamine. These studies have led to recent attempts to hasten or extend language and sensorimotor rehabilitation after human stroke by administration of catecholaminergic drugs. When used as an adjunct to behavioral therapy, such pharmacotherapy appears to have benefit. While drug therapy is unlikely to revolutionize the treatment of aphasia, it nonetheless holds promise as an adjunct to behavioral speech and language therapy to decrease performance variability and consequently to improve mean performance in patients with mild to moderate language dysfunction. Additional studies with carefully designed methods are necessary to assess the full potential of aphasia pharmacotherapy.

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Section: Augmentation Of Brain Dopaminementioning

confidence: 92%

Pharmacotherapy of aphasia. A critical review.

Small

1994

Stroke

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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: 97%

“…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). However, the latter clinical trials did not comprise parallel behavioral training, which may be a requirement for adjuvant dopaminergic therapy success (Korsukewitz et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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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“…The influence of such interventions was not measured in pragmatic measures of communication or in an overall disability scale. Two controlled trials failed to show any significant benefit from the use of bromocriptine [110,111]. Regarding piracetam, two randomized controlled studies [112,113] showed a significant advantage of the piracetam-treated group in some measures of the Aachen Aphasia Test, but in one of these studies no differences were noticed after 24 weeks [112].…”

Section: Treated Vs Non-treated Patientsmentioning

confidence: 99%