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Friday, 4 October 2013

Nicotine Patches - Autism, Alzheimer's and MCI

Following on from my last, rather science-heavy post, in which I became convinced of the possible value of nicotine patches in autism, I found that in the field of Alzheimer’s, their therapeutic value has already been established.

Autism is indeed not Alzheimer’s, but studies on brain samples in both diseases  have shown the same diminished acetylcholine and nicotinic receptor activity.  Also, note that the two Alzheimer’s drugs Donepezil and Galantamine, that are acetylcholinesterase inhibitors, were successfully trialed in autism.  I had proposed that nicotine patches might do the same job and hopefully without the side effects.

Alzheimer’s research is well funded.  You will below how the research is very professional.

 
Paul Newhouse, Clinical Neuroscience Research Unit, Vanderbilt University

Dr Newhouse has already been looking at the effect of nicotine on Alzheimer’s and MCI (Mild Cognitive Impairment) for many years.  Only in 2012 though did he publish his phase 1 clinical trial of nicotine patches in non-smokers with MCI.
"The trial involved 67 non-smokers with MCI, which is considered an intermediate between normal aging and dementia. People with MCI are more likely to develop Alzheimers's disease. 
Half of the patients wore a skin patch that delivered 15 milligrams of nicotine per day; the other half wore a placebo patch. The study was double-blinded, meaning both the patients and the researchers were unaware who was getting the drug.
After six months, patients who wore the nicotine patch regained 46 percent of their age-adjusted "normal performance" on long-term memory tests, whereas patients in the placebo group worsened by 26 percent."
It looks like even he was surprised at just how good the results were.  The improvement was profound and the patches were well tolerated.  Later stage trials will now follow.

 
Here is the 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.

 
Here is a lengthy Power Point presentation of his findings.

 
Conclusion
It is now clear that nicotine patches are effective in people with diminished acetylcholine and nicotinic receptor activity (which includes Alzheimer’s and Autism) and seem well tolerated by non-smokers.  As I pointed out in the last post, only a SMALL dose will work, a large dose will have the opposite effect. Dr Newhouse has actually tested this effect (see his presentation) and makes similar comments.  In the coming years, I am confident he will establish an excellent therapy for MCI and Alzheimer’s.  For Autism, I think it will remain a case of improvisation.  Note that in the trial they started with a low dose and built up to the 15mg patch over 21 days.  This dose was for adults.

Newhouse also suggests that nicotine may work better than the drug alternatives and might make a permanent (beneficial) change in subjects.  This was also suggested by other researchers in my previous post.
The patches can be cut like Sellotape/Scotch tape and they certainly do have an effect.  I know, because I am testing half a 15 mg patch right now.

7 comments:

  1. Hi,
    I know this is an old post but what where your conclusions? Did you test it for a long time?
    Best regards,
    João Santos

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    Replies
    1. Nicotine patches are effective for some people. It all depends on what is the cause of the underlying problem you are treating. I tried the patches for a few weeks trying to treat SIB (Self Injurious Behavior), any impact was marginal, but there were no side effects. Later I found a very effective treatment using Verapamil and mast cell stabilizers. I suggested a friend of a friend to try the patches and the result was great, and even the neurologist was surprised. It all depends what the underlying dysfunction is; so it remains a case of trial and error. For my son, the other type of cholinergeric receptors, muscarinic, seem to be more relevant. This would explain why Piracetam had a positive effect. Under the term autism are very many different conditions/dysfunctions, so what works for one person may, or may not, work in the next person. I think if the patches were to be effective, you would see it within a day or two.

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  2. I am autistic. I had selective mutism for 7 years. I thought it was a coincidence that I was able to speak after I started smoking.

    A couple years ago, I was diagnosed with breast cancer. I attributed the accute change in functioning to effects from chemotherapy, I now wonder if it has more to do with {mostly] giving up nicotine.

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    Replies
    1. Very interesting; perhaps it would be worth trying nicotine gum or patches?

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  3. Oh that's great info i never would have guessed, thanks !!

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  4. I have a 16 year old daughter DIAGNOSED with Autism, M.r. and Ceribal Pulsy.. she has started hitting, and screaming over the last few years. How can i get her to keep patch on if she won't leave bandages on?? Doesnt chew gum? Help??

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    Replies
    1. Tabatha, you can stick the patch on her back where she cannot reach it. Since you only need part of a patch, it is easy to apply it in the bathroom in the morning without her even noticing. Nicotine and the nicotine agonist drugs used by people to stop smoking do help a sub-group of people with autism and self injury. But there are many biological causes for self injury. For my son the cause was allergy related and is resolved by verapamil. If nicotine does not help, try verapamil, if effective it will be evident within 20 minutes.

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