Cerebrolysin: A Promising Nootropic for Dementia from Pig Brains?

According to the World Health Organization, an estimated 50 million people worldwide are living with dementia, and this number is projected to triple by 2050. As the global population ages, the search for effective treatments to delay the progression of this debilitating disease has become increasingly urgent.

Recently, nootropics — also known as “smart drugs” or “cognitive enhancers” — have emerged as a potential solution for patients suffering from cognitive dysfunction. One of the nootropics clinically being used for stroke, neurodegeneration, traumatic brain injury, and dementia is Cerobrolysin, a nootropic derived from pig brains.

In this article, we will dive into the science behind Cerebrolysin and its promising effects on dementia treatment.

What is Cerebrolysin?

Cerebrolysin® is a drug containing low-molecular-weight peptides (<10 kDa) and free amino acids derived from the pig brain. It is prepared in a solution containing sodium hydroxide and water and is administered parenterally — any non-oral means of administration.

It has neuroprotective and neurotrophic effects and is indicated for patients with acute ischemic stroke, dementia, Alzheimer’s disease, and traumatic brain injury.

Cerebrolysin® is generally safe and well-tolerated. Its adverse effects are rare, mild, and transient.

How does Cerebrolysin work?

Cerebrolysin® crosses the blood-brain barrier and affects neurovascular tissues. Modifies two major signaling pathways: the neurotrophic factor (NTF) and the sonic hedgehog (SHH) signaling pathway.

Molecularly, these pathways regulate various cellular processes such as cell differentiation, neuronal survival, nerve cell function, protection, and repair. Cerebrolysin® also stimulates the formation of new synapses and neurogenesis in the dentate gyrus, a brain region critical for learning and memory.

Cerebrolysin usage

Cerebrolysin has profound neuroprotective effects; hence, it is applied in several brain-related disorders, including stroke, traumatic brain injury, dementia, Alzheimer's disease, and other psychiatric/behavioral disorders.

Stroke

In a prospective, randomized, double-blind, placebo-controlled clinical study, Cerebrolysin® showed a beneficial effect on global neurological status and disability of patients with acute ischemic stroke.

In combination with early physical rehabilitation, participants who received Cerebrolysin® demonstrated significant improvement in global neurological status at 10 and 30 days. A high percentage of participants with significant improvement in disability are from the group who received Cerebrolysin® (73.3%) compared to the placebo group (44.83%).

However, some findings suggest that the drug has little or no beneficial effect in preventing death in acute ischemic stroke. Evidence even indicates a potential increase in non-fatal serious adverse effects with Cerebrolysin® use.

Traumatic brain injury

Cerebrolysin® offers beneficial effects even in patients with a severe disability after having a traumatic brain injury (TBI).

In a cohort study where 10 mL of Cerebrolysin® was administered daily for 30 days in patients with severe disability one month after a traumatic brain injury (TBI), the participants who received the drug had a lower mortality rate and better recovery after six months of therapy.

Cerebrolysin® use was also associated with higher favorable and lower unfavorable outcomes. However, it was also associated with a higher seizure rate.

Dementia

The 2019 Cochrane Review on Cerebrolysin® in vascular dementia, with six studies that include a total of 597 people living with the disease, supports the beneficial effect on memory and cognition without risk of side effects.

However, the review states that the results are not definitive due to the issues with the studies that may have led to misleading results. A larger study is still needed.

Alzheimer’s disease

Cerebrolysin® is widely studied as a drug for Alzheimer’s disease.

Systematic review findings show that Cerebrolysin® is superior to placebo in improving global outcome measures and cognitive ability in patients with Alzheimer’s.

In a study by Roshchina et al., results show that Cerebrolysin® can even delay cognitive deterioration in mild to moderate AD for more than one year. This is longer than the delay benefits from using AChE inhibitors, the usual drug of choice for AD.

Other psychiatric disorders

The potential effect of Cerebrolysin® as a mood stabilizer for certain illnesses like schizophrenia is still being examined.

A study using mass-spectrometric and bioinformatics analysis shows that Cerebrolysin® does not affect the serotonergic, adrenergic, nor GABAergic systems. Further findings from a rat study of neurodegeneration show that Cerebrolysin® increases dopamine metabolism and has therapeutic efficacy.

Other behavioral disorders

In a study examining the potential effects of Cerebrolysin® in children with autism, results show that the group of children with exogenous autism who were given Cerebrolysin® showed signs of improvement using the Childhood Autism Rating Scale (CARS).

In a clinical trial where the safety and efficiency of Cerebrolysin® were determined by CARS on behavioral, verbal, and nonverbal developments of children with autism, all evaluated items, except the level and consistency of behavioral response, had favorable reductions.

However, its partial use as an intervention may be limited by the large number of intramuscular injections needed to be administered.

Cerebrolysin side effects

Mild and transient side effects of Cerebrolysin® include vertigo, agitation, and feeling hot. However, it may cause diaphoresis, sweating, dizziness, and palpitations if injected too quickly. Erythema, pruritis, and burning sensation may also be observed at the injection site.

However, rare cases of hyperventilation, hypertension, hypotension, tiredness, tremor, depression, apathy, dizziness, and influenza-like symptoms have been reported.

It remains to be safe even when used in adjunct with recombinant tissue-type plasminogen activator or cholinesterase inhibitors such as donepezil or rivastigmine and without also associated with any significant changes in vital signs or laboratory parameters.

How to use Cerebrolysin?

Cerebrolysin® is administered parenterally over a total of 10 to 20 days.

For adults with organic brain disorders, metabolic disorders, and neurodegenerative diseases, 5 to 30 mL of the drug should be given daily.

For adults with post-apoplectic complications and craniocerebral trauma, 10-50 mL daily is recommended to be given.

For children, only 1 to 2 mL of the drug daily should be administered.

Contraindications

Cerebrolysin® is contraindicated in patients with:

• Hypersensitivity to any of its components;
• Severe kidney impairment;
• Epilepsy.