Future Prospects


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Future Prospects: Nootropics

Nootropics were introduced more than 20 years ago with piracetam as the prototype. The name is derived from noos (mind) and tropin (toward), and their pharmacologic effects are focused on improving higher cerebral functions, such as integration and memory (Ban 1995). Piracetam is a cyclic derivative of gama-aminobutyric acid (GABA), and several analogs have been synthesized, including oxiracetam, etiracetam, promiracetam, and aniracetam. These medications are used experimentally and have not been released for patient use in the United States. Extensive animal testing has shown positive effects on memory, object recognition, performance in radial mazes, and passive and active avoidance (reviewed by Mondadori 1994). Human studies have shown that a subgroup of patients with dementia (10-30%) have improved memory with nootropics, and this effect seems to be mediated by cholinergic systems (Mondadori 1993, 1994). In both Down syndrome and in dyslexia, there is evidence that the combined effects of piracetam and educational programs can enhance some types of learning compared to controls (Deberdt 1994). Since the cholinergic system may be affected by the lack of FMRP in FXS (see chap. 1), studies regarding the benefit of nootropics in FXS are warranted.

Future Prospects: Donepezil (Aricep)

Another agent used in Alzheimer disease, which also works on the cholinergic system, is donepezil (Aricep). This medication is a cholinesterase inhibitor that enhances the effect of acetylcholine, which in turn enhances the glutamatergic system. The combined effect on both systems enhances memory and learning in aging rats. Results are similar in human studies. This medication is being studied in children with ADHD and has the potential for benefit in children with FXS.

Future Prospects: Continued

Ampakines

This article is not intended to give medical advice for individual cases. Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals. Some of the terms will be unfamiliar to those who are not trained in medical fields.

*This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002. It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website.

The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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