On 50 (full text) - a study of old people in a mental hospitol whose psychiatric illness was considered to be in 'remission' - 2.4g/day and 4.8g/day both improved intelligence, but 4.8g/day slightly degraded "verbal IQ" (which includes working memory) and some "memory quotient" (table 3, pg103).

They speculate that other studies showed no significant benefit for N=20 only because the dose was too low or the timeframe too short (2.4g/day showed P<0.5 improvements after more than 8 weeks (not yet significant at 4 weeks), but 4.8g/day gave significant improvements after 4 weeks and 8 weeks, with a decline at 12 weeks, though not in all measures erasing all the benefit compared to the placebo group).

The analysis seems competently done; the 3 groups (N=20 each) were purely randomly chosen, not balanced for other traits, so for instance the 2.4g/day group was dumber than the other groups before intervention; they corrected for this in analysis.

In table 2 (pg 102), higher scores are worse for SCAG and BPRS, and the opposite (higher=good) for nurse CGI (Clinical Global Impression - some subjective measure of "is the patient doing better") and CGRS. Placebo group had no CGI improvement; both 2.4 and 4.8 had a huge improvement. As for negative effects, 4.8g/day had slightly more diziness (P>.1 however), and 2.4g/day had significantly worse cooperation and sleep. It seems like everyone had worse sleep, so I don't know what to make of that, but they claim it's significant after ANOCovariance.

They also claim an anecdotal dose-dependent decrease in parkinsonian-like facial tremor symptoms (i.e. 4.8g/day was more effective), which seems contrary to 51's claim of 'tremor' as a common piracatem side effect.

Anyway, piracatem definitely helps old and/or in-'remission' schizo/affective people think better (not sure if it's and or or).

Since the net benefit at week 12 of 2.4g/day was much more than 4.8g/day, I really want to know if there's some longer term (e.g. 50 weeks) where an even smaller dose (including none at all) of piracatem is better than 2.4g/day.

There's nothing about headaches or choline in this study either, except in the discussion section, they cite Bartus 1981 (rat study) and Friedman 1981 and Ferris 1982 (senile dementia improved more w/ choline+piracatem than with either alone).

Bartus RT, Dean III RL, Sherman KA, Friedman E, Beer B (1981) Profound effects of combining choline and piracetam on memory enhancement and cholinergic function in aged rats. Neurobiol Aging 2:105-111

Bartus RT (1981) Age-related memory loss and cholinergic dysfunction: Possible directions based on animal models. In : Crook T, Gershon S (eds) Strategies for the development of an effective treatment for senile dementia. Mark Powley, New Canaan, CT, pp 71-90

Friedman E, Sherman KA, Ferris SH, Reisberg B, Bartus RT, Schneck MK (1981) Clinical response to choline plus piracetam in senile dementia: Relation to red-cell choline levels. New Engl J Med 304:1490-1491

Ferris SH, Reisberg B, Friedman E, Schneck MK, Sherman KA, Mir P, Bartus RT (1982) Combination choline/piracetam treatment of senile dementia. Psychopharmacol Bull 18:94-98