Bacopa monnieri , popularly known as Brahmi, has been traditionally used in Ayurveda since ages for its memory enhancing properties. However, data on placebo-controlled trial of Bacopa monnieri on intellectual sample is scarce.
Hence this study was planned to evaluate the effect of Bacopa monnieri on memory of medical students for six weeks. To evaluate the efficacy of Bacopa monnieri on memory of medical students with six weeks' administration. Method and Material. This was a randomized double blind placebo-controlled noncrossover, parallel trial. Sixty medical students of either gender from second year of medical school, third term, regular batch, were enrolled from Government Medical College, Nagpur, India.
Baseline biochemical and memory tests were done. All baseline investigations were repeated at the end of the trial.
Students were followed up for 15 days after the intervention. Statistically significant improvement was seen in the tests relating to the cognitive functions with use of Bacopa monnieri.
Blood biochemistry also showed a significant increase in serum calcium levels still within normal range. Bacopa monnieri Linn. It is currently promoted as a brain tonic and many formulations are available. Various phytochemical studies have shown its chemical constituents to be alkaloids brahmine, herpestine, nicotine, saponin, monierin, hersaponin [ 1 ], Bacosides A1, A2 [ 5 ], A3 [ 6 ], and B [ 7 ], bacogenins A1 to A4 [ 8 ], steroids triterpene, and bacosine.
Bacopa extract has been shown to possess dose dependent free radical scavenging capacity and protective effect on DNA cleavage [ 14 ]. Its antioxidant property, which is about half potent to that of vitamin E on weight basis [ 15 ], is thought to be responsible for its antistress, immunomodulatory, cognition facilitatory, anti-inflammatory, and antiageing effect [ 16 — 23 ]. Its antilipid peroxidation property is credited to the memory enhancing action and it has been recommended for low dose long-term therapy rather than single high dose administration [ 15 ].
Animal studies have shown that it has anxiolytic, cognition enhancing, relaxing, bronchodilatory, antioxidant, anticancer, antidepressant, immunomodulatory, and anti-inflammatory effects [ 16 — 24 ].
Its anxiolytic activity was comparable to benzodiazepine but did not result in any significant motor deficit [ 16 ]. It improved acquisition, retention, and retrieval of learned tasks [ 16 — 18 ]. Mouse model shows that its antidepressant properties which may be due to its effect on serotonergic and noradrenergic nervous system [ 24 ]. It showed significant memory-promoting effect in animal models of Alzheimer's disease [ 16 ]. It has been shown to improve learning and memory in Wister albino rats [ 25 ] and even in our other published open label 6-month study in elderly Alzheimer's patients [ 26 ].
Trial with a Composite Indian Herbal Preparation CIHP , which amongst other constituents contained Brahmi, has been shown to be beneficial for soldiers serving at high altitudes and cold areas and in low intensity conflict situations. It improved their physical and mental efficacy [ 27 ]. Bacosides A and B improve the transmission of impulses between the neurons.
Bacosides regenerate synapses and repair damaged neurons, thereby making it easier to learn and remember new information.
Brahmi increases brain serotonin, a neurotransmitter promoting relaxation [ 5 ]. Bacosides A and B influence cholinergic system [ 28 ]. Bacoside-rich extract reversed the cognitive deficit induced by intracerebroventricularly administered colchicine, a neurotoxin, and that induced by injecting ibotenic acid into the nucleus basalis magnocellularis [ 29 ].
The potent antioxidant property exerted by Brahmi has been shown to be due to metal chelation at the initiation level and also as a chain breaker [ 15 ].
Standardized extract of Bacopa monnieri induced a dose related increase in superoxide dismutase, catalase, and glutathione peroxidase levels in rat prefrontal cortex, striatum, and hippocampus [ 28 ]. The antioxidant property, also seen by its protective effect on human fibroblast DNA, suggests its application in diseases where free radicals play a key role [ 14 ].
Bacopa significantly improved speed of visual information processing, learning rate, memory consolidation, and decreased anxiety with maximal effects after 12 weeks of administration. The study suggested that it might improve higher order cognitive processes like learning and memory [ 31 ].
Follow-up study with higher single dose in a double blind, placebo-controlled trial showed improved and sustained cognitive performance [ 34 ]. Chronic effects of Bacopa when assessed on memory functions in 76 adults from 40 to 60 years' age group, for three months, showed significant effects on retention of new information [ 35 ].
In mild cognitive impairment patients, single dose of Bacopa monnieri and Sideritis scardica extracts showed improvement in d2-concentration test [ 36 ]. Most of the reports relate to Bacopa 's efficacy on memory and cognition in healthy normal individuals but some also relate to Attention Deficit Hyperactivity Disorder ADHD children [ 37 ], some of which are ongoing [ 38 ].
Unfortunately, only a few randomized, placebo-controlled human trials have been published [ 39 ]. A review found only 6 such trials which mainly examined effects of Bacopa on memory. There is also paucity of data on effects of Bacopa on other cognitive domains like attention, associative abilities, reasoning, transformation, and language comprehension. Since none has been attempted on a select, exclusive group of participants with high intellectual level, like medical students, we planned this study to see whether the drug is effective in improving cognitive functions in medical students after 6 weeks of treatment.
Our rationale behind this exclusive sample was that medical physicians are known to have a very high intellectual level [ 41 ].
So we wanted to see if Bacopa monnieri can improve cognition in the group of medical students with already high cognitive functions. This was a randomized double blind placebo-controlled, noncrossover, parallel trial conducted on outdoor basis.
Bacopa Monnieri Benefits for Brain, Memory, Focus and Attention - Crystalline Nutrients
After Institutional Ethics Committee approval, the students of either gender, second year medical school, third term regular batch from Government Medical College, Nagpur, India were requested to participate in the trial. Detailed information sheet relating to the trial was provided to the students willing to participate.
All their questions relating to the trial were answered. They were free to consult peers, doctors, teachers, parents, and so forth, about their participation in the trial. They were told that that their nonparticipation will not affect their student academic life. Students were explained their right to drop out of the trial anytime they wished to, without any questions being asked.
First 60 students found compliant with the inclusion-exclusion criteria were entered in the trial.
Informed, written, witnessed consent was obtained from them. A battery of tests was prepared in consultation with clinical psychologists and computer experts. These tests were pretested on five students. The tests were administered to the participants a week before the start of trial for experience. One-week washout was given.
The standardized extract of Bacopa monnieri Bacognize for our trial has been shown to improve some aspects of cognitive functions in a 6-month trial in geriatric Alzheimer's patients [ 26 ]. It has also been shown to be safe and have sustained cognitive effects when used for 12 weeks in healthy older adults [ 45 ].
Dosage was chosen based on previously reported trials [ 26 , 31 , 34 , 35 ]. It was further confirmed by methods given in Indian Pharmacopeia. Plant material was washed with water.
The methanol extract was concentrated and the material was spray-dried to get powder. Autosampler carry-over was determined by first injecting the highest calibration standard before a blank sample.
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Negligible carry-over was observed, as indicated by the lack of Bacopa glycosides peaks in the blank sample. Total of four bacosides were The participants were impressed to take the medicines regularly and record the miss, if any, and provide the information of missing intake during next visit.
The participants were recalled after 15 days for review, ADR monitoring, and refill of medicine.
They were instructed to bring back all the unused medicines. Compliance was calculated from returned medicine. All returned medicines were discarded and fresh supply was issued for next 15 days.
Such three reviews made up the total duration of therapy 45 days. After completion of the drug run-in, all baseline tests were repeated. The order of posttest was the same as the pretest. The medicine was decoded. The participants were followed up for 15 days after stopping the intervention. A battery of established auditory and visual neuropsychological tests was chosen aiming to assess immediate recall, recognition, working memory, attention, associative abilities, reasoning, transformation, and language comprehension.
These included digit span memory task, paired associate task, logical memory test, memory span for nonsense syllables, finger tapping test, simple and choice reaction time, choice discrimination test, and digit picture substitution test.
These tests give results in the form of scores. The higher the score, the better the participants' performance. The details of each test are given below.
It involves immediate verbal recall of numbers, varying from 6 to 10 digits, and consists of digit span forwards and backwards. Digit span forwards requires recall of the series of numbers in the same order as given. The test measures are closely related to the efficiency of attention freedom from distractibility.
Digit span backwards requires immediate recall of the spoken numbers in the reverse order. Measuring the elements of working memory, it requires both recall and subsequent manipulation of the incoming information [ 47 ].
Digit span is a subset of the WAIS-R, which has exhibited good test-retest reliability, with coefficients 0. It consists of 10 predetermined word pairs.
Participants are first presented with the pairs before the start of the test. In this they are told one member of the pair and are required to verbally give the other part of the pair. Associative abilities enable the participants to connect the stimuli and events. This test requires reasoning and transformation [ 52 — 54 ].
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This test consists of a memory passage. Parallel forms are used in predrug and postdrug testing.
The test measures immediate recall of the logical material and language comprehension. High comparability has been reported between the alternate forms [ 48 ]. The test measures immediate memory involving meaningless material with the help of recognition [ 55 ].