title: Nicergoline improves dysphagia by upregulating substance P in the elderly.
abstract: Dysphagia induces silent aspiration, which is a known risk factor for aspiration pneumonia in the elderly. Dysphagia is associated with impaired substance P secretion. Because nicergoline was recently reported to enhance substance P secretion, it may improve dysphagia by upregulating substance P; however, roles for nicergoline in this process have not been demonstrated. We therefore compared the effects of nicergoline on serum substance P and dysphagia with the effects of imidapril, an angiotensin-converting enzyme (ACE) inhibitor whose efficacy in improving dysphagia and preventing pneumonia has been previously demonstrated.We randomly assigned 60 elderly patients with both dysphagia and a previous history of pneumonia to receive either imidapril (5 mg/d; n = 30) or nicergoline (15 mg/d; n = 30) for 6 months. Primary outcomes were the effects of these drugs on the substance P level and dysphagia 4 weeks after the start of treatment. Secondary outcome was the effect of these drugs on pneumonia recurrence during the 6 months of treatment.Significant elevations of serum substance P were obtained by both medications after 4 weeks of treatment. Patients whose dysphagia was improved showed significantly increased serum levels of substance P. There was no statistically significant difference in the overall proportion of patients who showed improvements in dysphagia and pneumonia recurrence with imidapril or nicergoline treatment. Nicergoline, but not imidapril, seemed to be more effective at improving dysphagia and elevating serum substance P in patients with dementia.In conclusion, nicergoline has a comparable effect to ACE inhibitors for improving dysphagia. Nicergoline might be a novel regimen for the treatment of dysphagia in the elderly who are not treatable with ACE inhibitors.
authors.affiliation: From Department of Respiratory Medicine (TN, MO, JY), Hiroshima General Hospital of West Japan Railway Company, Hiroshima; Department of Molecular and Internal Medicine (NH, NK), Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Nakashima
authors.forename: Noboru
authors.initials: N
authors.lastname: Hattori
authors.forename: Mafumi
authors.initials: M
authors.lastname: Okimoto
authors.forename: Jitsuro
authors.initials: J
authors.lastname: Yanagida
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Kohno
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003679:Deglutition / Q000187:drug effects; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D048289:Imidazolidines / Q000627:therapeutic use*; D008297:Male; D009530:Nicergoline / Q000627:therapeutic use*; D010865:Pilot Projects; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D020127:Recovery of Function; D012016:Reference Values; D012720:Severity of Illness Index; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D013373:Substance P / Q000097:blood / Q000187:drug effects*; D016896:Treatment Outcome; D015854:Up-Regulation / Q000187:drug effects
chemical_list: D000317:Adrenergic alpha-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D048289:Imidazolidines; D013373:Substance P; C065166:imidapril; D009530:Nicergoline