***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Piracetam , 1-pyrrolidone acetamid , was tested in 40 chronic alcoholics with a more or less marked psycho-organic syndrome by means of psychological tests . It was a double-blind-cross-over study . Statistical analysis of the results showed that Piracetam improves the energo-functional capacity of the cortex i.e. the basal functions of the cortical cells such as activating capacity , vital dynamic , flexibility , intellectual reactivity and stress tolerance . Apart from the overall improvement we also observed an improvement of specific cerebral performances which is however unimportant in comparison with the greneralized effect Using a r and omized , double blind group comparison , the efficacy and tolerance of piracetam as an additional therapy of hydroxyethyl starch , venous infusion and low dose heparin treatment , which are the basis of therapy in our hospital , has been studied in patients displaying acute cerebral ischemia . A total of 56 patients were enrolled , of whom 27 were given piracetam and 29 served as a control during a 28-day period . Using single photon emission computer tomography ( SPECT ) analysis , we observed that in 23 piracetam-treated patients ( 85.2 % ) a reduction in the area of brain regions displaying an impaired flow rate occurred ( P < 0.001 ; Fisher 's exact two-sided test ) . Only six of placebo-treated patients ( 20.7 % ) showed an improved flow rate . Analysis of the recorded computer tomography map gave an improvement coefficient > 2 ( flow rate marginally or better improved ) for 23 piracetam patients as compared with 5 placebo patients ( P < 0.001 , Uleman test ) The authors reanalyzed previously published data from a prospect ively r and omized , placebo-controlled , double-blind phase-III study of 130 in patients with dementia syndrome . The patients in the study had been diagnosed as having suffered from organic brain syndrome ( ICD 290 ) , which is the core syndrome of dementia ( so-called dementia syndrome ) for at least two years . They were treated with piracetam for three months at a dose level of 4,800 mg/d . These data were reexamined in order both to survey the extent of drug-related improvement and response rates when assessed at different levels and to investigate the comparability of efficacy in subgroups suffering from either senile dementia of the Alzheimer type or multi-infa rct dementia . Three scales were used for the assessment of efficacy . They were the CGI , or Clinical Global Impression , completed by the physicians ; the SCAG , or S and oz Clinical Assessment Geriatric , used by clinical psychologists ; and the BGP , or Beurteilungsskala für Geriatrische Patienten ( Evaluation Scale for Geriatric Patients ) , employed by the nursing staff . The Syndrome-Kurztest ( SKT ) and Benton tests served to measure performance . The items and subscores of the SCAG and the SKT were highly intercorrelated at baseline , forming a common factor fairly independent of the information gained by BGP . This suggests that merely using different kinds of information-gathering methods , i.e. , clinical scales and performance tests , completed by different groups of observers , does not automatically result in nonredundant comprehensive information . When using the most conservative response criterion of individual improvement , i.e. , at least one baseline st and ard deviation , treatment with piracetam showed statistically significant ( pe less than .001 ) explorative response rates of 50 % and above in three out of four target variables , as compared to the 0 to 6 % obtained with placebo . CGI was used as descriptive variable . Again , using this response criterion from a separate analysis of diagnostic subgroups , as matched by the median of the patients ' Hachinski Ischemic Scale scores , it does not appear that piracetam 's efficacy for patients with senile dementia of the Alzheimer type ( SDAT ) varies with its efficacy for patients with multi-infa rct dementia ( MID ) 1 . Enhancement of episodic memory and reduction of intrusion errors are considered as the most characteristic outcome of cholinergic drugs administration in AD patients . 2 . Since the nootropic drugs Piracetam and Oxiracetam are deemed to act through a cholinergic mechanism , we checked whether AD patients treated with these drugs would show the same pattern of neuropsychological improvement . 3 . Results were negative , since ( a ) episodic memory showed a similar degree of improvement both in patients treated with these drugs and in patients treated with placebo ; ( b ) the number of intrusions tended to increase , rather than to decrease , after the treatment period Piracetam has been described to improve neuroleptic-induced acute extrapyramidal syndrome where a central dopaminergic hyperactivity is implicated . In Huntington 's chorea , this abnormality is also generally admitted , at least functionally . Therefore the authors have utilized piracetam in this disease . The drug was administered intravenously in a double-blind study to 6 patients .  Piracetam worsened choreic movements . This result is discussed in relation to the pharmacological properties of the drug Nootropics , a new class of drugs believed to activate mental functions , have been proposed as a treatment for clinical disorders in which cognition is impaired . We therefore administered the nootropic drug piracetam , alone and in combination with phosphatidylcholine ( PC ) , to 18 patients with Alzheimer 's disease ( AD ) , and measured the effects of treatment on a broad range of cognitive functions .  Piracetam was administered according to three double-blind crossover protocol s and a replication study that differed in piracetam dose ( 2.4 to 9.9 g/day ) and whether PC ( 18 g/day ) was administered concurrently . The drug was well tolerated , and there were not toxic side effects . Plasma choline levels rose significantly during piracetam and PC administration ; monoamine metabolites in cerebrospinal fluid were unaffected by treatment . Piracetam , either alone or in combination with PC , did not significantly affect cognition in the AD group as a whole , nor did it improve test performance in any single patient Fifty-six hospitalized geriatric patients between the ages of 65 and 80 were given piracetam ( Nootropil ) 2400 mg/day or placebo on a double blind basis over a two month period . Every patient su bmi tted to a battery of psychological tests before and after the two month trial . These tests included the Similarities , Vocabulary , Digit Symbol , and Block Design subtests of the Wechsler Adult Intelligence Scale ; Graham Kendall Memory for Design ; Benton Visual Retention ; Hooper Visual Organization ; Raven Colored Progressive Matrices A , AB , and B ; Wechsler Memory Scale A and B ; Porteus Maze and Finger Tapping .  Patients who were unable to complete this battery were not included in this investigation . In addition , at pretreatment , 4 and 8 weeks , the patient completed a Profiles of Mood States , a Clinical Global Evaluation was done by the investigator , and laboratory determinations were performed . Fifty Patients completed the investigation ( 25 piracetam  , 25  placebo )  . There were no significant statistical differences between the two groups of patients on all measures utilized except for the Clinical Global Evaluation , where 52 % of the patients on piracetam showed minimal improvement versus 25 % of the placebo group ( P less than 0.05 ) Pre clinical research suggests that piracetam ( a nootropic drug ) may improve cognitive functions , but previous studies have failed to demonstrate a clear benefit for the treatment of Alzheimer 's disease ( AD ) . We report a 1-year , double-blind , placebo-controlled , parallel-group study with a high dose of piracetam ( 8 g/d per os ) in 33 ambulant patients with early probable AD . Thirty subjects completed the 1-year study . No improvement occurred in either group , but our results support the hypothesis that long-term administration of high doses of piracetam might slow the progression of cognitive deterioration in patients with AD . The most significant differences concerned the recall of pictures series and recent incident and remote memory . The drug was well-tolerated A double-blind , placebo-controlled trial was carried out on 109 aged patients with minimal or with moderate chronic brain failure to assess the effectiveness of piracetam ( 2.4 g per day ) in preventing the progression of dementia . Patients received piracetam or placebo each for 6 weeks , the order of treatment being at r and om . The results of 19 psychological tests , repeated at 6-weekly intervals , showed that piracetam produced statistically significant improvement in only one of them and then only during the first 6 weeks of treatment . These findings , therefore , do not support the usefulness of piracetam in the treatment of such patients A group of 80 elderly subjects affected with recent onset ( less than 6 mth ) slight to moderate mental deterioration was observed before and after oral drug treatment for a period of 28 wk . The study consisted of four r and omized groups of subjects homogeneous for age , sex and life habits . The first group received a placebo , the second group received piracetam ( 1600 mg 3 times a day ) , the third group received pentoxifylline ( 400 mg 3 times a day ) , and the fourth group received a combination of piracetam and pentoxifylline . At the beginning and end of each phase of the study , neuropsychological and haemorheological parameters were evaluated in all subjects . The results show that the most evident improvement in psycho-intellectual performance , associated with an increase of whole blood filtration values , was obtained in the group treated with the two-drug combination The following paper presents an investigation of the efficacy of piracetam in alcoholic organic mental disorder . A double-blind placebo-controlled study design was used to compare 2 dosages of the substance ( 2 X 3 g vs. 2 X 12 g ) . Cognitive function was assessed on days 0 , 7 , 14 , 28 , 42 . Analysis of the results from 24 patients showed a clear-cut amelioration of cognitive functions in all 3 treatment groups . No difference could be demonstrated between the administration of placebo and the lower dose of piracetam . Patients on the higher dose showed an earlier improvement on one of the tests , but the final scores were similar in all three treatment groups 101 elderly motorists with reduced reaction capacity were examined under real traffic conditions with regard to their driving ability . They were given a daily dose of 4.8 g piracetam or placebo over a six-week period in a r and omised double-blind study . The percentage of correctly solved sign-observance items , which reflects orientation and perception in real traffic conditions , increased in the placebo-treated test-group from 79.86 % in the pretest to 80.07 % in the retest , whereas the test subjects of the piracetam-treated group improved their performance from 77.08 % to 84.16 % . After being treated with piracetam for 6 weeks , the drivers showed a significantly better performance than the placebo-group . Of particular interest is the finding that the test-subjects who had scored less than 80 % in the pretest improved without exception in the retest after treatment with piracetam PURPOSE In normal aging persons , oxygen and glucose consumption progressively decreases with reduced cerebral blood flow ( CBF ) , which could be responsible for age-related changes in cognitive functions . A data processing model with the use of Tc-99 m SPECT of the human brain has been developed and found to be sensitive for monitoring the effects of drugs that increase CBF . In this study , the effect of two vasodilator drugs ( the combination of pentifylline and nicotinic acid versus piracetam ) was compared with the effect of placebo on CBF . MATERIAL S AND METHODS Thirty elderly volunteers had three different procedures using the Peelproc method to spatially st and ardize and compare CBF patterns by SPECT before and after drug intervention . The 30 patients were divided into five groups of six persons each who were r and omly assigned in a 1:1 ratio to the treatment sequences consisting of three phases : the combination of pentifylline and nicotinic acid ( C ) , piracetam ( N ) , and placebo ( P ) , or C-N-P ; P-N-C ; P-C-N ; N-C-P ; C-P-N ; or N-P-C. Phases 1 to 3 each consisted of a baseline recording of parameters ( day 0 ) , treatment for 60 days ( days 1 to 60 ) , and recording of parameters after treatment ( day 61 ) . RESULTS In elderly human volunteers ( ages , 52 to 70 years ) , after 2 months of oral treatment with a combination of pentifylline and nicotinic acid ( 800 mg pentifylline , 200 mg nicotinic acid daily ) , SPECT results for the Peel-proc program indicated a statistically significant improvement in CBF of the total brain , with a more pronounced improvement in the cerebellum and frontal regions , where a definite shift from abnormal to normal blood flow was detected . Spontaneous communication from most of the volunteers suggested that they experienced an improvement in memory and general well-being from the combination treatment . After 2 months of oral treatment with piracetam ( 2.4 g daily ) in elderly human volunteers , SPECT results indicated a regional improvement in CBF , particularly in the cerebellum . However , no beneficial effects with this drug were spontaneously reported . CONCLUSION The in vivo method to quantitatively monitor the progress of long-term drug therapy on CBF described here could be useful to assess and even direct changes in therapy The report is based on 315 patients with subacute and chronic cerebral circulatory disturbances caused mostly by atherosclerosis aged 30 to 82 years , treated for 1 - 6 months . In 90 cases Piracetam ( Nootropil ) was given 
    Output:
    
The evidence of effects on cognition and other measures , was inconclusive .
REVIEW ER 'S CONCLUSIONS At this stage the evidence available from the published literature does not support the use of Piracetem in the treatment of people with dementia or cognitive impairment because effects were found only on global impression of change but not on any of the more specific measures .