Nicotine treatment of mild cognitive impairment: a 6-month double-blind pilot clinical trial.
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.


CONCLUSIONS
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.


METHODS
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.
Clinical Neuroscience Research Unit, Department of Psychiatry, University of Vermont College of Medicine, Burlington, USA. Paul.Newhouse@vanderbilt.edu
P
P
Newhouse
K
K
Kellar
P
P
Aisen
H
H
White
K
K
Wesnes
E
E
Coderre
A
A
Pfaff
H
H
Wilkins
D
D
Howard
E D
ED
Levin
D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention / Q000187:drug effects / Q000502:physiology; D001835:Body Weight / Q000187:drug effects; D060825:Cognitive Dysfunction / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011939:Mental Recall / Q000187:drug effects; D009483:Neuropsychological Tests; D009538:Nicotine / Q000008:administration & dosage*; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011930:Reaction Time / Q000187:drug effects; D055986:Vital Signs / Q000187:drug effects
D018722:Nicotinic Agonists; D009538:Nicotine