title: Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract.
abstract: BACKGROUND
  Bacopa monnieri has a long history in Ayurvedic medicine for neurological and behavioral defects. To assess its efficacy in improving cognitive function.
  
  
  METHODS
  MEDLINE, EMBASE, CINAHL, AMED, Cochrane Central of clinical trial, WHO registry, Thai Medical Index, Index Medicus Siriraj library and www.clinicaltrial.gov were searched from the inception date of each database to June 2013 using scientific and common synonyms of Bacopa monnieri, cognitive performance or memory. The reference lists of retrieved articles were also reviewed. Randomized, placebo controlled human intervention trials on chronic ≥ 12 weeks dosing of standardized extracts of Bacopa monnieri without any co-medication were included in this study. The methodological quality of studies was assessed using Cochrane's risk of bias assessment and Jadad's quality scales. The weighted mean difference and 95% confidence interval (95% CI) were performed using the random-effects model of the Dersimonian-Laird method.
  
  
  RESULTS
  Nine studies met the inclusion criteria using 518 subjects. Overall quality of all included trials was low risk of bias and quality of reported information was high. Meta-analysis of 437 eligible subjects showed improved cognition by shortened Trail B test (-17.9 ms; 95% CI -24.6 to -11.2; p<0.001) and decreased choice reaction time (10.6 ms; 95% CI -12.1 to -9.2; p<0.001).
  
  
  CONCLUSIONS
  This meta-analysis suggests that Bacopa monnieri has the potential to improve cognition, particularly speed of attention but only a large well designed 'head-to-head' trial against an existing medication will provide definitive data on its efficacy on healthy or dementia patients using a standardized preparation.
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand; Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Thailand; Center of Excellence for Environmental Health & Toxicology, Naresuan University, Thailand. Electronic address: chuenjidk@nu.ac.th.
authors.forename: Chuenjid
authors.initials: C
authors.lastname: Kongkeaw
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand; Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Thailand; Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Piyameth
authors.initials: P
authors.lastname: Dilokthornsakul
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand.
authors.forename: Phurit
authors.initials: P
authors.lastname: Thanarangsarit
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand.
authors.forename: Nanteetip
authors.initials: N
authors.lastname: Limpeanchob
authors.affiliation: Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok 65000, Thailand; Center of Excellence for Environmental Health & Toxicology, Naresuan University, Thailand.
authors.forename: C
authors.initials: C
authors.lastname: Norman Scholfield
mesh_terms: D034681:Bacopa / Q000737:chemistry*; D003071:Cognition / Q000187:drug effects*; D006801:Humans; D010936:Plant Extracts / Q000737:chemistry / Q000494:pharmacology*
chemical_list: D010936:Plant Extracts
keywords: ADHD; AVLT; Bacopa monnieri; Brahmi; Cognition; MCI; MMSE; Nootropic; Speed of attention; attention deficit hyperactivity disorder; auditory verbal learning test; mild cognitive impairment; mini mental state examination