Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 62557

AbstractMaterial and MethodsResultsDiscussionReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
ĹKnowledge is treasure of a wise man.ĺ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help oneĺs reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsľNo manuscriptsľNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : December | Volume : 3 | Issue : 6 | Page : 1827 - 1835

The Psychomotor Effects Of Brahmi And Caffeine On Healthy Male Volunteers

RAINA R S*, CHOPRA V S**, SHARMA R***, KHAJURIA V****, SAWHNEY V*****, KAPOOR V******

Abstract

Background: Brahmi enhances cognitive processes including comprehension, memory and recall. Caffeine is undoubtedly the most widely used psychoactive substance in the world.
Aim: To compare the psychomotor performance of brahmi and caffeine.
Setting: Postgraduate Department of Pharmacology and Therapeutics of a Medical college
Material and Methods: 40 healthy male medical student volunteers were given Brahmi (250 mg) or Caffeine (100 mg) twice a day after meals for 16 weeks. Two types of psychomotor performance tests were conducted on the subjects at 0 (before the consumption of drug), 2, 4, 6, 8 and 12 weeks. Instrumental tests included a Simple Reaction Time Task (SRT), a Multiple Choice Reaction Time Task (MCRT), a Critical Flicker Fusion Threshold Task (CFFT) and a Tracking Performance Task (TPT) whereas, non -instrumental tests included a Digit cancellation task (DCI), a Memory test (MT) and a Mental arithmetic task (MAT).
Results: Out of these subjects, two dropped out from the caffeine group due to unpleasant side effects at week 2. At 16 weeks, Brahmi caused significant decrease in the MCRT score than caffeine (P<0.05), while at 12 and 16 weeks, Brahmi significantly improved the CFFT score than caffeine (P<0.05). After 8 weeks onwards, Brahmi caused significant increase in the DCT score than caffeine (P<0.05). MT scores were significantly better in the caffiene group than in the Brahmi group at 12 weeks (P<0.001).Brahmi showed significant increase in the MAT score than caffeine in 8, 12 and 16 weeks (P<0.05).
Conclusion: From the results of the present study, we conclude that Brahmi can prove to be a supplement of utmost utility to improve cognitive functions.

Keywords

Brahmi, cognitive functions, caffeine

Introduction
Brahmi (Bacopa monniera) has a long history of use in ayurveda for treating a number of disorders like anxiety, poor memory, epilepsy, insomnia and asthma. (1),(2) It has been tested as a nootropic that enhances cognitive processes including comprehension, memory and recall. The ethanolic extract of Bacopa has been used to increase the activity of antioxidative enzymes (e.g superoxide dismutase, glutathione peroxidase and catalase) in the frontal cortex, striatum and hippocampus of rats. (3) Bacopa also increases the level of serotonin, a brain chemical, to promote relaxation.(4) Caffeine is undoubtedly the most widely used psychoactive substance in the world. Caffeine, a xanthine alkaloid compound, is a CNS stimulant having the power to temporarily ward off drowsiness and restore alertness. In the present study, we compared the psychomotor performance of brahmi and caffeine in healthy male volunteers.

Material and Methods

The study was carried out on 40 healthy male medical student volunteers in the age group of 25 ┬▒ 5 years in the Postgraduate Department of Pharmacology and Therapeutics of a Medical college. Prior to inclusion in the study, the volunteers were evaluated for general physical and systemic examinations and biochemical estimations like renal function test, liver function test, lipid profile and fasting blood sugar, haematological estimations like haemoglobin, TLC, DLC, urine and stool examination. Subjects with a history of renal or hepatic diseases, consumption of CNS affecting drugs for four weeks before starting the trial, smoking and alcohol consumption for the last four weeks prior to the drug administration, any intake of caffeine drinks 24 hours prior to the study or during the study and abnormality in answering the Eysenck personality questionnaire, were excluded from the study.

Forty male subjects fulfilling the above criteria were selected for the study after taking their informed consent. The subjects were trained daily for several days for psychomotor performance tests till their performance reached a stable level. All volunteers were randomly allocated into 2 groups. All the volunteers were evaluated for the pre drug scores on their psychomotor performance at 0 day. One of the following drug schedules was administered for 16 weeks:-
Group 1- Brahmi (250 mg) twice a day after meals
Group 2- Caffeine (100 mg) twice a day after meals
Each group was evaluated for post drug scores on the psychomotor performance tests at 2, 8 and 16 weeks and any reported adverse drug reactions were recorded.

Two types of psychomotor performance tests were conducted on the subjects at 0 (before the consumption of drug), 2, 4, 6, 8 and 12 weeks. The instrumental tests included a Simple Reaction Time Task (SRT), a Multiple Choice Reaction Time Task (MCRT), a Critical Flicker Fusion Threshold Task (CFFT) and a Tracking Performance Task (TPT), whereas, the non -instrumental tests included a Digit cancellation task (DCI), a Memory test (MT) and a Mental arithmetic task (MAT).

Simple Reaction Time (SRT) Task
The instrument consisted of two separate units; the first known as the stimulus controlling unit from which the presentation of four different coloured visual stimuli were regulated by pressing appropriate corresponding knobs. This unit also recorded automatically the time taken to respond to the stimulus.

The second unit consisted of a panel and a base. Four different coloured stimuli (Red, yellow, green and blue) were displayed on the panel and corresponding push buttons were present at the base. Visual stimuli were displayed to the subject by the investigator operating the stimulus controlling unit in another chamber. The coloured visual stimuli were presented to the subject at regular intervals and the subjects had to respond by pressing the key. The responding times to different stimuli were noted to an accuracy of 1/100th of a second. At each session, 20 such readings were taken and the mean of these readings was recorded in milliseconds.

Multiple Choice Reaction Time (MCRT) Task
The monitor of this apparatus had ten rows of coloured lights, each row having ten lights of red, yellow and green colours. The base of the equipment had buttons for respective colours. The equipment had an option for two programmes; each having a different sequence of appearance of the coloured light. The time taken for the response was displayed at the back of the equipment and the investigator categorized the responses into correct, delayed correct and wrong.

The subject was presented with a particular type of coloured light at a given time and he was supposed to press the corresponding button within 0.5 seconds. Such responses were recorded as correct responses. If the response occurred within 0.5 to 0.8 seconds then it was designated as delayed correct and if the wrong button was pressed, then the response was recorded as wrong. The total sum of correct, delayed correct, and wrong responses were subtracted from 100 to get the number of missed responses. At one sitting, four trials were recorded, two with each programme. The error index was calculated from the mean of these four trials.

The error index was calculated by the following formula: -
Error index (Ei) - Number of delayed responses + No. of wrong responses x 2 + no of missed responses x 3.

Critical Flicker Fusion Threshold (CFFT) Task
This task was carried out on the ‘Maq Lab’ digital critical flicker fusion threshold apparatus, a well-established neurophysiological technique that reflected the cortical function, especially of the occipital and the parietal lobe. This equipment consisted of two units; first, the viewer unit from where four light emitting diodes are viewed by the subject and the second unit which was operated by the investigator who controlled the frequency threshold. The investigator increased or decreased the frequency of the coloured lights from flicker to fusion or vice versa and the frequencies were recorded in hertz.

After a fixed period of accommodation, the frequency was increased and decreased progressively until the subject recorded a change in his flicker perception. The subject was tested five times with increasing frequency and fives times with decreasing frequency and the mean of these ten readings was calculated.

Tracking Performance Task (TPT)
The TPT score was measured on the ‘Maq Lab’ tracking task apparatus. It was a basic measure of the visual-motor co-ordination performance. The subject was presented a circular moving light on a screen and he had to track it with the hand held photocell stylus .The speed of moving light was 10 revolutions per minute around a circular track. The total time fixed for a single task was 30 seconds and five readings were noted in each session .The target rate per minute was calculated (the time for which the stylus remained on the target) according to the following formula;
Target rate per minute = Target time x 60
_________________
30

Digit Cancellation Task (DCT)
In a matrix of 400 digits, a particular digit was randomly distributed 40 times in the whole sample. The subject had the task of cancelling the specified digit as many times as possible in 30 seconds. Target digits were altered in subsequent sessions and the numbers of the cancelled digits were recorded in each session.


Mental Arithmetic Task (MAT)
The test was conducted according to the method described by Stone (1984). The subject was presented with a sheet containing 30 addition and 30 subtraction sums of three digit numbers and the total duration of 2 minutes was permitted for each exercise. Written calculations were not permitted and the subject had to complete as many sums as possible in the above specified time period. The number of sums attempted and the number of wrong answers were recorded.

Memory Test (MT)
A set of ten names of unrelated objects was read out to the subject and 1 minute was given to memorize them. After 20 minutes, the subject was asked to recall and write down as many objects as possible and his answer was recorded.

Statistical Analysis
The data obtained in each group at 2, 4,8,12 and 16 weeks were compared with pre drug values obtained at 0 day and values of different regimes were also compared in between. After the completion of the study, the data was analyzed with the help of Computer Software Microsoft Excel Windows. Mean ┬▒ SD were calculated for qualitative variables for all the four groups. Paired ‘t’ test was used to evaluate the statistical significance within a group from 0 to 16 weeks. Unpaired “t” test was used to compare the values between the two groups. ‘P’ values equal to or less than 0.05 were considered to be statistically significant.


Results

Out of these subjects, two dropped out from the caffeine group due to unpleasant side effects at week 2. Brahmi caused a significant decrease in SRT from the 4th week onwards. There was a significant decrease from the baseline score of -0.03 at 2 weeks (P=0.079), -0.10 at 4 weeks (P=0.003), -0.13 at 8 weeks (P<0.001),-0.14 at 12 weeks (P<0.001) and -0.14 at 16 weeks (P< 0.001). The maximum decrease was observed at 16 weeks (Table/Fig 2). The pretrial SRT score of volunteers receiving caffeine was 0.66 ┬▒ 0.10. After caffeine intake, these was decrease in the SRT score of -0.004 at 2 weeks (P>0.05), -0.03 at 4 weeks (P<0.001), -0.13 at 8 weeks (P<0.001), -0.13 at 12 weeks and -0.13 at 16 weeks. The maximum decrease in score was seen at the 12th week. The MCRT baseline score was 136.6 ┬▒ 13.94 in the brahmi group and it was reduced by -6.12 at 2 weeks (P>0.05), -14.44 at 4 weeks (p<0.001), -19.42 at 8 weeks ( P< 0.001) , -23.2 at 12 weeks ( P <.001) and -24.6 at 16 weeks (P<0.001) .The maximum reduction in the MCRT score was seen at 16 weeks. The score of the error index also decreased significantly from 4 weeks onwards in the caffeine group. There was a decrease from the baseline score of -0.50 at 4 weeks (P<0.001), -7.194 at 8 weeks (P<0.001), -7.264 at 12 weeks (P<0.001) and -7.381 at 16 weeks (P<0.001). Maximum reduction was observed at 16 weeks (Table/Fig 3).

Brahmi increased the critical flicker fusion frequency score throughout the study period. The score was increased from a mean value of 34.61 ┬▒ 1.90 by +1.06 at 2 weeks (P<.05), +1.08 at 4 weeks (P<0.05), +1.27 at 8 weeks (P<0.001), +1.58 at 12 weeks (P<0.001) and +1.76 at 16 weeks (P<0.001) (Table/Fig 2). The modification in the CFFT score was statistically significant from the 2nd week onwards, and remained constant from 8th week onwards. The CFFT score also showed significant improvement from 4 weeks of the study in the caffeine group. From a mean baseline score of 34.29 ┬▒ 2.53, it was increased by +0.08 at 2 weeks (P>0.05), +0.41 at 4 weeks (P<0.001), +0.98 at 8 weeks (P<0.001), +0.96 at 12 weeks (P<0.001) and +1.0 at 16 weeks (P<0.001). The maximum improvement was seen at 16 weeks.

Brahmi caused a significant increase in the TPT score from the 2nd week of the study. There was significant increase in the score from the baseline score of +1.41 at 2 weeks (P<0.05), +5.23 at 4 weeks (P<0.001), +7.07 at 8 weeks (P<.001), +7.49 at 12 weeks (P<0.001) and +7.82 at 16 weeks (P<0.001). The maximum increase in theTPT score was observed at 16 weeks. There was significant increase in the TPT score from the mean baseline score of +1.84 at 2 weeks (P<0.05), +7.51 at 4 weeks (P<0.001), +7.76 at 8 weeks (P<0.001), +7.08 at 12 weeks (P<0.001) and +7.68 at 16 weeks (P<0.001) in the caffeine group .The increase in the score was maximum at 8 weeks of the study (Table/Fig 3).

The DCT score was found to be increased throughout the study period from a mean baseline value of 20.150 ┬▒ 2.11 to 21.1 ┬▒ 2.614(+0.95) at 2 weeks (P<0.05), 21.75 ┬▒ 2.359 (+1.6) at 4 weeks (P<0.001), 22.65 ┬▒ 2.159(+2.5) at 8 weeks (P<0.001), 23 ┬▒2.94 (+2.85) at 12 weeks (P<0.001) and 23 ┬▒ 2.753 (+2.85) at 16 weeks (P<0.001) in the brahmi group. The improvement in the DCT score was statistically significant from the 2nd week onwards, with maximal improvement at 12 weeks.

There was a significant increase in the DCT score from the mean baseline score of 19.83 ┬▒ 2.53 to 21.67 ┬▒2.521 (+1.833) at 2 weeks (P<0.001), 22.33 ┬▒ 2.425 (+2.5)at 4 weeks (P<0.001), 22.39 ┬▒ 2.33(+2.556) at 8 weeks (P<0.001), 22.44 ┬▒ 2.281(+2.61) at 12 weeks (P<0.001) and 22.67 ┬▒ 2.40(+2.83) at 16 weeks (P<0.001) in the caffeine group. Maximum increase was observed at the 16th week.

Brahmi showed significant improvement on the MT score after the 4th week till the end of the study. The mean baseline score was increased by +0.35 at 2 weeks (P>0.05), +0.7 at 4 weeks (P<0.05), +0.8 at 8 weeks (p<0.001), +1 at 12 weeks (P<0.001) and +1.25 at 16 weeks (P<0.001). The MT score increased significantly from 4 weeks onwards, with the maximum score in the 16th week.

Caffeine caused a significant improvement in the MT score from the 2nd week of the study. From the mean baseline score of 7.44 ┬▒ 1.097, there was a significant increase of +0.94 at 2 weeks (P<0.001) , +1.50 at 4 weeks (P<0.001), +1.88 at 8 weeks (P<0.001), +1.77 at 12 weeks and +1.72 at 16 weeks (P<0.001). The peak effect was observed at 8 weeks (Table/Fig 3) . There was a significant increase in the MAT score from the mean baseline score of 17.4 ┬▒ 2.501 to 18.9 ┬▒ 2.693(+1.5) at 2 weeks (P<0.001) ,19.85 ┬▒ 2.87 (+2.45) at 4 weeks (P<0.001), 20.4 ┬▒ 3.185 (+3) at 8 weeks (P<0.001) , 20.1 ┬▒ 3.144 (+2.7) at 12 weeks (P<0.001) and 20.4 ┬▒ 3.251 (+3) at 16 weeks (P<0.001) in the brahmi group. Maximum increase was seen at 16 weeks. Caffeine showed statistically significant improvement in the MAT score from the 2nd week of the study. The mean baseline score increased from 17 ┬▒ 2.657 to 18.11 ┬▒ 3.142 (+1.11) at 2 weeks (P<0.001), 18.39 ┬▒ 2.953 (+1.389) at 4 weeks (P<0.001), 18.89 ┬▒ 2.948 (+1.889) at 8 weeks (P<0.001), 18.83 ┬▒ 3.015 (+1.833) at 12 weeks (P<0.001) and 19.17 ┬▒ 3.258 (+2.167) at 16 weeks (P<0.001).The peak score was obtained at 16 weeks.

Comparative Effect Of Brahmi And Caffiene On Various Parameters:
At 16 weeks, Brahmi caused significant decrease in the MCRT score than caffeine (P<0.05),
while at 12 and 16 weeks, Brahmi significantly improved the CFFT score than caffeine(P<0.05).

After 8 weeks onwards, Brahmi caused significant increase in the DCT score than caffeine (P<0.05).

MT scores were significantly better than Brahmi in the caffiene group at 12 weeks (P<0.001).

Brahmi showed significant increase in the MAT score than caffeine at 8, 12 and 16 weeks (P<0.05). All drug regimens were well tolerated. Only four volunteers reported adverse events in the caffeine group, with complaints of palpitation, insomnia, irritability and dyspepsia (one volunteer each).Palpitation and insomnia were observed before the 2nd week in two subjects and they dropped out from the trial. No adverse effect was reported with Brahmi.

Discussion

One of the major dilemmas faced by the human race is that their cerebral abilities diminish significantly with advancing age and is compounded by factors like emotional stress. There have always been efforts to identify the beneficial agents which could be used to alleviate debilitating disorders and retard mental deterioration. In this direction, pharmaceutical companies continue to invest enormous resources to identify such potentially beneficial agents.

One such plant that has been used to restore debilitating conditions is Bacopa monniera or Brahmi.
In the present study, a comprehensive battery of tests which comprised of instrumental and non-instrumental tests, were chosen to obtain a broad coverage of perceptual, motor and intellectual functions. These tests have been identified as being the most sensitive tests (5).
Brahmi shortened the reaction time from 2 weeks onwards, with its peak at 16 weeks (P<0.001). These findings indicate that Brahmi helps to respond quickly to stimulus. Our results are in accordance with the study by Stough et al (2001) who reported that on chronic use of Brahmi, there was significant improvement in the speed of visual information processing and reaction time(6). Earlier, Bacopa had been found to produce improvement in perception and reaction time without any side effects in school children aged 6-8 years (7).

Caffeine (100 mg) administration produced significant decrease in SRT from 4 weeks onwards and remained of the same magnitude throughout, with maximum reduction at 16 weeks (p<0.001) as reported earlier (8),(9),(10)


MCRT is a psychomotor test which not only measures the latency of sensori-motor coordination, but also has the ability to recognize stimulus and the decision ability to react.Therefore, in addition to sensori-motor co-ordination, it measures attention monitoring abilities. The effects of Brahmi on MCRT which were calculated as the error index, revealed that its effects significantly decreased from 4 weeks, with maximum beneficial effects at 16 weeks (P<0.001). This means that Brahmi not only improves SRT, but also the complex reaction time where the critical processing for detection perception, recognition, decision making and integration, are involved. Our findings are in agreement with Kidd et al, who in their three months study have also observed that Brahmi improves reaction, performance time and immediate memory (7).

There was reduction in the MCRT score after the use of caffeine (100 mg) in comparison to the baseline score from 4 weeks onwards. Maximum reduction was observed at 12 weeks. Similar results have been published by Haskell et al, who observed that complex tests like digit vigilance reaction time and numeric working memory reaction time showed improvement (10). However, Judelson et al have observed no significant improvement in the number of correct responses or the mean latency of the response in four choice reaction time tasks (11). This could be due to the short duration of their study and procedural disparity than in our study.

CFFT is a measure of the central mechanism involving cortical arousal or integration and is a more direct measure of CNS activity. Brahmi caused improvement in CFFT from the 2nd week onwards, with maximum effects at 16 weeks (P<0.001). Stough et al have also reported improvement in CNS integrative tests, like the speed of visual information processing which is measured by AVLT (6).

The results of the present study with caffeine showed significant improvement from the 4th week (P<0.001) and showed peak improvement at 16 weeks (P<0.001) in CFFT test. There are however numerous other reports where no effect of caffeine on CFFT has been found. (12),(13) However, in these studies short course high dose of caffeine was given (≤500 mg) in contrast to our study in which small doses of caffeine were administered for 16 weeks.

However, in contradiction to our results, Hindmarch has reported a dose dependent reduction in CFFT with an acute dose of 4 mg/Kg and 8 mg/Kg of caffeine, which were given to healthy subjects at night and were tested on the following morning (14). This discrepancy to our results can be explained on the basis that high doses given at bed time disrupted sleep, leading to fatigue on the following morning and resulted in the impairment of CFFT.

The most basic measure of Visio-motor performance is the tracking task which offers a mean of assessing divided attention and the response output mechanisms required for fine motor control.

The effect of Brahmi on TPT improved significantly from the 2nd week (P<0.05) and was maximum at 16 weeks (P<0.001) in the present study. However, the effect of caffeine improved from the 2nd week onwards and the maximum effect was seen at 8 weeks (P<0.001). The increase in the TPT score was not significant after 8 weeks, which indicates that the effect of caffeine was not generally long lasting on the parameters.

DCT is a measure of the perceptual processing of the central sensory information with regards to the current information and its matching with previously stored or pre-existing information. The analysis of the observation of the present study reveals that the DCT score was enhanced by Brahmi from 4 weeks onwards, with its peak at 16 weeks (P<0.001). Caffeine (100mg) showed significant increase in the DCT score from the 2nd week, with its peak at 16 weeks (P<0.001) as reported earlier. (13)

Short term memory is a limited capacity store of processed information which functions in a variable time period and is dependent on the demands of the task situation to assist stimulus recognition and processing. The limbic system is involved in learning and memory. The short term memory improved significantly in response to Brahmi from 4 weeks (P<0.05) and lasted throughout the study, with the maximum effect at 16 weeks (P<0.001). This observation is in conformity with the finding of Stough et al who evaluated the effects of Brahmi on memory and anxiety and found improvements in the memory rates and reduction in anxiety levels, with maximal effects evident after 12 weeks (6).

Roodenrys et al, have investigated the effect of Brahmi (300 mg) on the retention of new information i.e. recalling of a pair of unrelated words after a short delay and have found significant improvement on these tests. They suggested that it could be due to the antioxidant effect of Brahmi within the hippocampus area of the brain (15).

Jyoti and Sharma have shown that the co-administration of Bacopa significantly prevented the aluminum-induced decrease in SOD (Superoxide dismutase) activity,, as well as the increased oxidative damage to lipid and protein in the hippocampus part of the brain (16).

Kidd has demonstrated significant improvements in anxiety (P<0.005) and immediate memory span (P<0.01) when treated with Bacopa(13). Joshi and Parle have also documented that Brahmi significantly improves learning memory in young mice and that it even reversed the amnesia induced by both scopolamine and natural ageing (17). They concluded that Brahmi significantly decreases whole brain acetycholinestrase activity and acts as a useful memory restorative agent in the treatment of dementia in the elderly.

The MT score improved by intake of caffeine from 2nd week onwards with peak beneficial effects at 8 weeks (P<0.001) as reported earlier (10),(13). The observations from the present study show that caffeine a widely used psychomotive substance is a facilitator of the memory in the present dose in young adults. However, our results differ form the reports of Child E et al , who observed impaired memory tasks. But contrary to our study their was an acute trial where subjects were assessed 40 minutes after intake of 50, 150 and 200mg of caffeine.

MAT, a measure of central processing activity, improved significantly with Brahmi from 4 weeks till the completion of the study (P<0.001). This could be because of improved acquisition, retention and retrieval of learned tasks and the ability of Brahmi to reduce mental fatigue significantly (19).

The effects of caffeine on the MAT score (both addition and subtraction) revealed significant improvement from the 2nd week to the completion of the study (P<0.001). Our observations are closely related to that of Katy et al, who have documented that there was a significant increase on the rapid information processing task score with 250 mg of caffeine (13). Smit et al have documented similar results of caffeine on the rapid information processing task with different doses of caffeine. These findings suggest that caffeine favourably affected the processing activity of CNS (9).

Brahmi being lipophilic, can easily penetrate the blood brain barrier and attain effective concentration in the CNS, thus leading to central effects. On comparison with caffeine, Brahmi was found to be the more effective of the two. No serious adverse events occurred during the present study.

Pravina et al have also observed no untoward effects in the trial of 23 subjects who were given Brahmi in doses of 300 to 450 mg for 30 days, which was identical to the dose used in the present study (500 mg) (20). Caffeine leads to adverse drug reactions like palpitation, insomnia, dyspepsia and irritability. Caffeine is well known for a wide range of unpleasant physical and medical conditions including nervousness, irritability, anxiety, tremulousness, muscle twitching, insomnia and palpitation. Furthermore, its higher dose can lead to peptic ulcers and reflux esophagitis. (21).

To summarize, it can be said that Brahmi being lipophilic, can enter the brain and affect complex tasks in a favourable way, involving the central attentive and integration processes of the CNS to a varying degree However, caffeine, a know psychostimulant suffers from the disadvantage of causing insomnia, irritability, dyspepsia and palpitation in some subjects. This study suffers from the limitation of having a short duration (16 weeks) and therefore, the generalization and conclusion drawn from the present results need to be carefully evaluated in the diseased group on a chronic basis.

From the results of the present study, we conclude that brahmi can prove to be a supplement of utmost utility to improve cognitive functions.

References

1.
Singh HK and Dhawan BN. Neuro-psychopharmacological effects of the Ayurvedic nootropic Bacopa monniera Linn. (Brahmi). Ind J Pharmacol 1997 ; 295: 359-65.
2.
Das A, Shanker G, Nath C, Pal R, Singh S and Singh H A. Comparative study in rodents of standardized extracts of Bacopa monniera and Ginkgo biloba: anticholinesterase and cognitive enhancing activities.Pharmacol Biochem Behav 2002; 73(4):893-900.
3.
Bhattacharya SK, Bhattacharya A, Kumar A and Ghoshal A. Antioxidant activity of Bacopa monniera in rat frontal cortex, Striatum and hippocampus. Phytotherp Resp 2000; 14: 174-9.
4.
Rastogi S, Pal R, Kulshresththa DK. Bacoside A3- a triterpenoid saponin from Bacopa monniera. Phytochemistry 1994; 36(1): 133-37.
5.
Hindmarch I and Clyde CA. The effects of triazolam and nitrazepam on sleep quality, morning vigilance and psychomotor performance. Arzneim. Forsh (Drug Res) 1980; 30:1163-6.
6.
Stough C, Lloyd J, Clarke J, Downey LA, Hutchison CW, Rodgers T , Nathan PJ. The chronic effects of an extract of Bacopa monniera on cognitive function in healthy human subjects. Psychopharmacology (Berl) 2001; 156(4): 481-4.
7.
Kidd DM. A review of Nutrients and Botanicals in the integrative management of cognitive dysfunction. Altern Med Rev 1999 ; 4(3): 144-61.
8.
Rogers PJ, Martin J, Smith C, Heatherley SV, Smit HS. Absence of reinforcing, mood and psychomotor performance effects of caffeine in habitual non-consumers of caffeine.Psychopharmacology (Berl) 2003 ; 167(1): 54-62.
9.
Smit HJ, Rogers PJ. Effects of low doses of caffeine on cognitive performance, mood and thirst in low and higher caffeine consumers. Psychopharmacology (Berl) 2000 ; 152(2): 167-73.
10.
Haskell CF, Kennedy DD, Wesnes KA and Scholey AB. Cognitive and mood improvements of caffeine in habitual consumers and habitual non-consumers of caffeine. Psychopharmacology (Berl) 2005; 179(4): 813-25.
11.
Judelson DA, Armstrong LE, Sokmen B, Roti MW, Casa DJ, Kellogg MD. Effects of caffeine intake on choice reaction time, mood and visual vigilance. Physiol Behav 2005 ; 85(5): 629-34.
12.
Bruce MS, Lader M. Caffeine abstention in the management of anxiety disorders . Psychol Med 1989 Feb; 19(1): 211-214.
13.
Katy R, David A, Malcolm L. The influences of age and caffeine on psychomotor and cognitive function. Psychopharmacol 1999; 145: 181-88.
14.
Hindmarch I.Instrumental assessment of psychomotor functions and effects of Psychotropic drugs. Acte Psychiatr Scand Suppl 1994; 380: 49-52.
15.
Roodenrys A, Booth D, Bulzomi A, Phipps A, Micallef C , Smoker J. Chronic effects of Brahmi (Bacopa monnieri) on human memory. Neuropsychopharmacology 2002; 27(2): 279-81.
16.
Jyoti A, Sharma D. Neuroprotective role of Bacopa monniera extract against aluminium - induced oxidative stress in the hippocampus of rat brain. Neurotoxicol 2006; 27: 451-7.
17.
Joshi H, Parle M. Brahmi rasayana improves learning and memory in mice. Evid Based Compliment Alternat Med 2006; 3(1): 79-85.
18.
Childs E, De wit H.Subjective, behavioral and physiological effects of acute caffeine in light, non-dependent caffeine users. Psychopharmacol (Berl) 2006; 185(4): 514-23.
19.
Singh RH, Singh L. Studies on the anti-anxiety effect of the medyha rasayana drug, Brahmi (Bacopa monniera wettst Part-I). J Res Ayur Siddha 1980; 1: 133-48.
20.
Pravina K, Ravindra KR, Goudar KS, Vinod DR, Joshua AJ, Wasim P, et al. Safety evaluation of BacoMind in healthy volunteers: a phase I study. Phytomed 2007 ; 14(5):301-8.
21.
Erowid caffeine vault:Effects of caffeine.The Voults of Erowid 2006 July 8.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com