Bacopa monnieri

Bacopa extract verbetert mogelijk het geheugen bij ouderen

Reviewed: Morgan A, Stevens J. Does Bacopa monnieri improve memory performance in older persons? Results of a randomized, placebo-controlled, double-blind trial. J Altern Complement Med. 2010;16(7):1-7.

Bacopa (Bacopa monnieri, Scrophulariaceae) is an aquatic plant that has been used in Ayurvedic medicine to enhance memory, intellectual function, and longevity. Several randomized, blind, controlled clinical trials demonstrate the benefits of bacopa extract on memory and learning, including one that also improved depression and anxiety measures in the elderly without dementia.1 A Phase I clinical trial demonstrated the safety and tolerability of BacoMind™ (Natural Remedies Pvt. Ltd., Bangalore, India), a standardized extract of bacopa, in healthy volunteers.2 The purpose of this randomized, placebocontrolled, double-blind study was to evaluate the efficacy and safety of BacoMind in older people (the population that experiences memory impairment).Researchers recruited participants from the general population of Northern Rivers region, New South Wales, Australia via media announcements and staff at Southern Cross University, Lismore, New South Wales, Australia. Volunteers 55 years or older who were without dementia or depression as assessed with validated scales were included. Participants had to be healthy and not using psychoactive medications, herbal medications, recreational drugs, or consuming more than 4 alcoholic drinks per day.Participants (n = 98; average age 65 years; range 55-86 years) were randomized to receive one 300 mg tablet/day BacoMind or placebo for 12 weeks. BacoMind is an alcoholic extract (herbto-extract ratio, 20:1) standardized to contain total bacoside saponin content of 40%-50%. BacoMind is standardized to 9 active constituents: bacoside A3, bacopaside I, bacopaside II, jujubogenin, bacopasaponin C, bacosine, luteolin, apigenin, and b-sitosterol-D-glucoside. The dosage evaluated was based on the manufacturer’s recommendation and was taken after a meal. Compliance was assessed by counting tablets at the end of the study.

Efficacy was evaluated with 3 validated neuropsychologic tests and a memory complaint questionnaire. The Rey Auditory Verbal Learning Test is a word-list learning test to assess aspects of memory including immediate recall, delayed recall, and retroactive and proactive interference. Rey-Osterrieth Complex Figure Test assesses visuospatial ability and visual memory. Trail Making Test measures scanning and visuomotor tracking, and involves cognitive processing (including memory) along with psychomotor speed. The Memory Complaint Questionnaire quantifies subjective memory complaints of aging.

At baseline, there were significant differences between treatment groups in the mean scores on the Rey-Osterrieth delayed recall tasks at both 3 minutes (Bacopa 18.2 ± 6.4; placebo 14.6 ± 5.9; P=0.005) and 30 minutes (Bacopa 18.3 ± 5.9; placebo 14.9 ± 6.4; P=0.008, respectively). There were no other baseline differences between groups. There were 17 withdrawals, including 9 in the bacopa group and 2 in the placebo group due to adverse effects, mostly gastrointestinal complaints (stool frequency, nausea, and abdominal cramps).

The Rey Auditory Verbal Learning Test consists of 15 tasks. Of these 15 tasks, BacoMind significantly improved memory function on 6 of the tasks compared with placebo: trial a4 (P=0.000) (the level in the paper; presumably this is a typographical error), trial a5 (P=0.016), trial a6 (postdistraction trial; P=0.000) (ditto), trial a7 (delayed-recall trial; P=0.001) (total learning summary trials a1–a5; P=0.011) and retroactive interference index (P=0.048). (Ed. Note: P values are somewhat suspect in this trial.) For all of the other efficacy tests there were no significant differences from placebo.

The authors conclude that bacopa significantly improves memory acquisition and retention in older Australians as measured by the Rey Auditory Verbal Learning Test. They state that the study demonstrated an improvement in the learning rate and had no effect on the forgetting rate. They caution against concurrent use of bacopa and acetylcholinesterase inhibitor medications, which are commonly prescribed for dementia. This study reported a higher incidence of GI side effects than was reported in the Phase I trial of BacoMind. This difference may be due to the older age of the population included in the current study, which may have a lower tolerability to bacopa, possibly due to its high saponin content.

This study was well designed and executed; however, an improvement on one test does not show decisively that bacopa improves memory acquisition and retention. This study bears repeating since there was a significant difference at baseline (a study limitation). It might also be constructive to evaluate a population with memory loss.

References

Oliff HS. Concentrated bacopa extract improves outcomes on cognitive and affective tests in elderly.HerbClip. February 13, 2009. (No. 090586-370) Austin, TX: American Botanical Council. Review of Effects of standardized Bacopa monnieri extract on cognitive performance, anxiety, and depression in the elderly: a randomized, doubleblind, placebo-controlled trial by Calabrese C, Gregory WL, Leo M, et al. J Altern Complement Med. 2008;14(6):707-713.

Oliff HS. Special extract of bacopa examined for safety. HerbClip. July 13, 2007. (No 060571-332) Austin, TX: American Botanical Council. Review of Safety evaluation of BacoMindTM in healthy volunteers: A phase I study by Pravina K, Ravindra KR, Goudar KS, et al. Phytomedicine. 2007;14:301-308.

Use of Bacopa monnieri in the Treatment of Dementia Due to Alzheimer Disease: Systematic Review of Randomized Controlled Trials

Aneesh Basheer 1, Ayush Agarwal 2, Biswamohan Mishra 2, Anu Gupta 2, Madakasira Vasantha Padma Srivastava 2, Richard Kirubakaran 3, Venugopalan Vishnu 2

Background: Bacopa monnieri, a herb that has been used for many centuries in India, has shown neuroprotective effects in animal and in vitro studies; human studies on patients with Alzheimer disease have been inconclusive.

Objective: The primary objective of this review was to determine the clinical efficacy and safety of B. monnieri in persons with mild, moderate, or severe dementia, or mild cognitive impairment, due to Alzheimer disease.

Methods: We searched PubMed, Embase, Cochrane Library, clinical trial registries (World Health Organization, Australia-New Zealand, United States, and South Africa), the metaRegister of Controlled Trials, and CINAHL. We intended to include all randomized and quasi-randomized controlled trials that compared B. monnieri, its extract or active ingredients (at any dosage), with a placebo or a cholinesterase inhibitor among adults with dementia due to Alzheimer disease and in those with mild cognitive impairment due to Alzheimer disease.

Results: Our comprehensive search yielded 5 eligible studies. A total of 3 studies used B. monnieri in combination with herbal extracts while the remaining 2 used B. monnieri extracts only. Two studies compared B. monnieri with donepezil while the others used a placebo as the control. There was considerable variation in the B. monnieri dose used (ranging between 125 mg to 500 mg twice daily) and heterogeneity in treatment duration, follow-up, and outcomes. The major outcomes were Mini-Mental State Examination scores reported in 3 trials, Cognitive subscale scores of the Alzheimer's Disease Assessment Scale in 1 study, and a battery of cognitive tests in 2 studies. Using the Cochrane risk-of-bias tool, overall, we judged all 5 studies to be at high risk of bias. While all studies reported a statistically significant difference between B. monnieri and the comparator in at least one outcome, we rated the overall quality of evidence for the Alzheimer's Disease Assessment Scale-Cognitive Subscale, Postgraduate Institute Memory Scale, Mini-Mental State Examination, and Wechsler Memory Scale to be very low due to downgrading by 2 levels for high risk of bias and 1 more level for impreciseness due to small sample sizes and wide CIs.

Conclusions: There was no difference between B. monnieri and the placebo or donepezil in the treatment of Alzheimer disease based on very low certainty evidence. No major safety issues were reported in the included trials. Future randomized controlled trials should aim to recruit more participants and report clinically meaningful outcomes.

Brahmi, hersentonicum?

Bacopa monnieri, in de Ayurvedische geneeskunde bekend als Brahmi, is een eeuwenoud en interessant kruid omdat het redelijk uniek is in zijn soort. Vooral de positieve werking op ons geheugen en alertheid lijkt een aantrekkelijke eigenschap waar wegens het ontbreken van beschikbare werkzame middelen in de geneeskunde behoefte aan is. We bespreken hier de werkzaamheid, de veiligheid en de mogelijkheid om Brahmi met reguliere middelen te combineren.

Een waterplantje dat in sommige delen van de wereld sinds eeuwen als hersentonicum wordt ingezet, is Bacopa monnieri. In de ayurveda is de stof ook wel bekend onder de naam Brahmi; dit betekent in het Sanskriet ‘bewustzijn’ of ‘wijsheid’. In de traditionele Ayurvedische geneeskunde wordt het beschouwd als een adaptogeen en zenuwtonicum. In het Westen staat Bacopa monnieri vooral bekend als het Alzheimerplantje. Brahmi maakt deel uit van de familie Plantaginaceae. De plant wordt gebruikt als keuken- en medicinaal kruid. Hij bevat van nature een grote hoeveelheid antioxidanten. Met name het effect op ons brein is interessant.

In een studie werden 62 gezonde respondenten onderworpen aan neuropsychologische tests om het niveau van hun cognitie te testen. Na 90 dagen bleek het gebruik van Brahmi een significant positief effect te hebben op het werkgeheugen en op de vaardigheid om visuele informatie te verwerken.1 De afgelopen twintig jaar is er veel onderzoek gedaan naar de toepasbaarheid van Brahmi bij geheugenverbetering, maar ook bij zenuwziekten en alzheimer. De plant bevat namelijk bacosiden als actieve bestanddelen. Deze groep plantverbindingen ondersteunt het leervermogen, geheugen en de mentale activiteiten.

Een ander onderzoek rapporteert over de effecten van Brahmi op het geheugen. Zesenzeventig volwassenen namen deel aan een dubbelblinde, gerandomiseerde, placebo-gecontroleerde studie waarin verschillende geheugenfuncties werden getest en angstniveaus gemeten. De resultaten laten een significant effect van Brahmi zien op het vasthouden van nieuwe informatie. Vervolgtests toonden aan dat de snelheid van leren niet werd beïnvloed, wat suggereert dat Brahmi de snelheid van het vergeten van nieuw verworven informatie vermindert. Taken voor het beoordelen van aandacht, verbaal en visueel kortetermijngeheugen en het ophalen van pre-experimentele kennis werden evenmin beïnvloed. Brahmi en zijn bioactieve componenten vertonen neuroprotectieve eigenschappen waaronder vermindering van neuro-inflammatie en verbeteren de cognitieve functie en leergedrag.2

Bronvermelding:

1. Stough, C. et al (2008). Examining the nootropic effects of a special extract of Bacopa monniera on human cognitive functioning: 90 day double‐blind placebo-controlled randomized trial. Phytotherapy Research: 22(12), 1629-1634.

2. Dubey T, Chinnathambi S. Brahmi: An ayurvedic herb against the Alzheimer's disease. 2019 Nov 15;676:108153. Arch Biochem Biophys Epub 2019 Oct 14.

3. Morgan A. Stevens, J. (2010). Does Bacopa monnieri improve memory performance in older persons? Results of a randomized, placebo-controlled, double-blind trial. The Journal of Alternative and Complementary Medicine, 16(7), 753-759. 17946.

4. Kongkeaw C, Dilokthornsakul P, Thanarangsarit P, et al. Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract. J Ethnopharmacol 2014;151(1):528-35.

5. Siem H. Complementair ontgiften tijdens farmaca gebruik. Orthofyto April 2021. 10-11.

6. Kar A, Pandit S, Mukherjee K, Bahadur S, Mukherjee PK. Safety assessment of selected medicinal food plants used in Ayurveda through CYP450 enzyme inhibition study. J Sci Food Agric 2017;97(1):333-40. doi: 10.1002/jsfa.7739.

7. Ramasamy S, Kiew LV, Chung LY. Inhibition of human cytochrome P450 enzymes by Bacopa monnieri standardized extract and constituents. Molecules 2014;19(2):2588-601.

8. Kar, A., Panda, S., and Bharti, S. Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice. J Ethnopharmacol. 2002;81(2):281-285.

9. Siem H. Ashwaganda. Orthofyto juni 2017:6-7

10. Sukumaran, N. P., Amalraj, A., & Gopi, S. (2019). Neuropharmacological and cognitive effects of Bacopa monnieri (L.) Wettst - A review on its mechanistic aspects. Complementary therapies in medicine, 44, 68–82.