Patching the Deficit

Posted on February 7, 2012





Normally, a nicotine patch on someone’s arm is evidence that they are trying to quit smoking. But, soon, nicotine patches may be appearing on arms of the cognitively impaired.

A study published in the journal Neurology reported that transdermal nicotine administration improved the symptoms of cognitive impairment in nonsmoking adults. In a randomized, double-blind, placebo-controlled study, 74 nonsmoking adults with mild cognitive impairment received either 15 mg of nicotine or placebo daily for 6 months. (Most smoking cessation patches deliver between 7 and 21 mg of nicotine per day.) At the end of the study period, the subjects showed significant improvement in most measures of cognitive function, including attention, memory, and psychomotor speed. There was no statistically significant improvement in clinician-rated global impression. The nicotine showed exceptional safety and tolerability.

The nicotinic acetylcholine receptor system is believed to be a part of memory and attention processes in the brain, and, thus, is thought to be dysregulated in memory- and attention-related disorders, including amnestic cognitive impairment, schizophrenia, attention-deficit disorder, and Alzheimer’s Disease. Therefore, nicotinic agonists, like nicotine, are potential treatment options for the memory and attention impairment components of many diseases. Nicotine has already shown significant improvement in memory- and attention-related symptoms and inhibition of impulsive responses in psychiatric populations.

To date, the reports of the benefits of nicotine have come from nonsmoking populations who have some form of cognitive impairment. The same effects of nicotine are not seen in current smokers, nor are they seen in healthy individuals without cognitive impairment. In fact, in adults with no memory or attention deficits, nicotine actually decreases performance on a battery of cognitive tests.

Clinicians are far from recommending nicotine patches to every forgetful person they meet, but nicotine does represent an interesting therapeutic target in several memory- and attention-related disorders. (And explains, at least in part, attention-deficient and cognitively-impaired populations who self-medicate with a higher prevalence of cigarette smoking compared to healthy populations.) The long-term effects of chronic transdermal nicotine are not well defined and the clinical importance and significance of the cognitive improvement is yet to be determined, but larger, more comprehensive studies are underway to further investigate nicotine therapy.

Posted in: Medicinal