Nicotine treatment of mild cognitive impairment
A 6-month double-blind pilot clinical trial
- P. Newhouse, MD,
- K. Kellar, PhD,
- P. Aisen, MD,
- H. White, MD,
- K. Wesnes, PhD,
- E. Coderre, MSc,
- A. Pfaff, BA,
- H. Wilkins, BA,
- D. Howard, MS and
- E.D. Levin, PhD
- From the Clinical Neuroscience Research Unit, Department of Psychiatry (P.N., E.C., A.P., H.W.), and Center for Clinical and Translational Science (D.H.), University of Vermont College of Medicine, Burlington; Center for Cognitive Medicine (P.N.), Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN; Department of Pharmacology (K.K.), Georgetown University School of Medicine, Washington, DC; Department of Neuroscience (P.A.), University of California San Diego School of Medicine, San Diego; Departments of Medicine (H.W.) and Psychiatry and Behavioral Sciences (E.D.L.), Duke University School of Medicine, Durham, NC; and United BioSource Incorporated (K.W.), Chevy Chase, MD.
- Correspondence & reprint requests to Dr. Newhouse: Paul.Newhouse{at}vanderbilt.edu
Abstract
Objective: To preliminarily assess the safety and efficacy of transdermal nicotine therapy on cognitive performance and clinical status in subjects with mild cognitive impairment (MCI).
Methods: Nonsmoking subjects with amnestic MCI were randomized to transdermal nicotine (15 mg per day or placebo) for 6 months. Primary outcome variables were attentional improvement assessed with Connors Continuous Performance Test (CPT), clinical improvement as measured by clinical global impression, and safety measures. Secondary measures included computerized cognitive testing and patient and observer ratings.
Results: Of 74 subjects enrolled, 39 were randomized to nicotine and 35 to placebo. 67 subjects completed (34 nicotine, 33 placebo). The primary cognitive outcome measure (CPT) showed a significant nicotine-induced improvement. There was no statistically significant effect on clinician-rated global improvement. The secondary outcome measures showed significant nicotine-associated improvements in attention, memory, and psychomotor speed, and improvements were seen in patient/informant ratings of cognitive impairment. Safety and tolerability for transdermal nicotine were excellent.
Conclusion: This study demonstrated that transdermal nicotine can be safely administered to nonsmoking subjects with MCI over 6 months with improvement in primary and secondary cognitive measures of attention, memory, and mental processing, but not in ratings of clinician-rated global impression. We conclude that this initial study provides evidence for nicotine-induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies.
Classification of evidence: This study provides Class I evidence that 6 months of transdermal nicotine (15 mg/day) improves cognitive test performance, but not clinical global impression of change, in nonsmoking subjects with amnestic MCI.
GLOSSARY
- AD=
- Alzheimer disease;
- AE=
- adverse event;
- BMI=
- body mass index;
- CDR=
- Clinical Dementia Rating;
- CGIC=
- Clinical Global Impression of Change;
- CPT=
- Continuous Performance Test;
- CRT=
- Choice Reaction Time;
- MCI=
- mild cognitive impairment;
- OASR=
- Older Adult Self Report;
- OABCL=
- Older Adult Behavior Checklist;
- RT=
- reaction time
Footnotes
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Study funding: Supported by the NIH/NIA R01AG22462 and NIGMS M01 RR00109. Pfizer Inc provided the transdermal nicotine patches.
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Supplemental data at www.neurology.org
- Received May 24, 2011.
- Accepted August 31, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
