Bacopa (Bacopa monnieri) and its effect on cognitive functions

Bacopa has been at the center of research because of its effect on cognitive functions such as memory, focus and concentration. Numerous researches in the last thirty years have enabled a better understanding of the effects of this plant and the popularization of its application in the cognitive health segment.

AUTHOR: Ana Gjergja Sekulić, M.pharm., univ.mag. phytotherapy and dietotherapy

Bacopa monnieri (Scrophulariaceae) is a small creeping plant that grows naturally in India and tropical areas. (Figure 1) It likes moist and wet soil, shallow water and swamps, and is easy to grow if it has a sufficient amount of water available.

It is traditionally used in Ayurvedic medicine for the treatment of various disorders of the nervous system such as epilepsy and anxiety, and as a learning support for the development of memory and concentration. It is also used for digestive problems, skin diseases, and as an antipyretic and analgesic.1,2 Bacopa has been at the center of research precisely because of its effect on cognitive functions such as memory, focus and concentration. Numerous researches in the last thirty years have enabled a better understanding of the effects of this plant and the popularization of its application in the cognitive health segment.

The pharmacological action of bacopa is attributed to alkaloids, saponins and sterols. The main saponins are identified as bacoside A and bacoside B, alkaloids brahmin and herpestin, and sterols stigmasterol and beta­sitosterol.

Numerous other ingredients have also been identified, including betulinic acid and numerous bacosaponins. 3­7 As already mentioned, the focus of research is the effect of bacopa on brain functions. Some of the more interesting ones are highlighted below. (Table 1)

Anxiolytic and antidepressant effect

Research conducted on rats showed that bacopa extract containing 25% bacoside A showed anxiolytic activity comparable to lorazepam. An additional positive effect is manifested in the fact that the bacopa extract did not cause amnesia like lorazepam, but, on the contrary, showed an effect on improving memory.8

The antidepressant potential of bacopa extract tested in an animal study showed that a dose range of 20-40 mg/kg once a day for 5 days has an effect comparable to the standard antidepressant drug imipramine.

The same study suggested that the antidepressant and anxiolytic effects are mediated by the action on the mechanism of serotonin and gammaaminobutyric acid.9

Although animal studies have shown promising results, clinical studies of the anxiolytic and antidepressant effects of bacopa on humans are currently still scarce. A review by Brimson et al. from 2021, described four randomized, placebo­controlled, double­blind studies that used bacopa as monotherapy and two studies that used a multi­herb intervention, and analyzed levels of depression or anxiety. It is important to note that not all patients were diagnosed with clinical depression. The authors emphasize that it is very difficult to draw any general conclusion, given that the studies used different assessment and analysis methods, and some showed statistically significant results, while some did not. What is interesting to point out is the study that showed that the use of bacopa for a period of 12 weeks can reduce geriatric depression in Alzheimer's patients to the level of healthy people.10 The potential for use in the field of anxiety and depression certainly exists, but further research will certainly give more precise data on the profile of patients who could benefit from bacopa therapy.

Memory improvement

Various animal studies have shown that bacopa improves motor learning and the acquisition and retention of newly learned behavior.11 It also has a beneficial effect on improved memory acquisition and retention in pre­existing benzodiazepine and phenytoin therapy, where it reverses drug­induced amnesia and cognitive impairment.12,13

A clinical trial on people older than 55 years was conducted with a 12-week application of bacopa at a dose of 300 mg/day. It has been recorded that bacopa significantly improves the acquisition and retention of memory in the elderly.14 The test was also conducted on younger people, and the results showed that the application of 300 mg of bacopa extract containing 55% of combined bacosides for a period of 12 weeks significantly improves verbal learning, memory, consolidation and speed of early information processing. These effects were not recorded at the beginning, nor after five weeks of application of the preparation.15

A randomized, double­blind, placebo­controlled study including sixty older adults examined the effects of bacopa on attention, cognitive processing, working memory, and cholinergic and monoaminergic functions. The group treated with bacopa showed improved working memory, attention and cognitive processing. The study was conducted for 12 weeks, and the first changes were noticed after 4 weeks of application.16

Another study, randomized, double­blind and placebo­controlled, included 60 medical students. Bacopa extract (Bacognize), administered 2 x 150 mg twice a day, for 6 weeks, has been shown to significantly improve cognitive abilities and performance in various neuropsychological tests (logical memory test, digit span, memory task, etc.). That study showed that bacopa helps with better focus and concentration.17

One study was also conducted on children aged 6 to 14 years. The study was randomized, double­blind, placebo-controlled, and examined the effectiveness of bacopa on cognitive performance. Bacopa is do­ sed 1 x 160 mg for body weight 20-35 kg, and 2 x 160 mg for body weight over 35 kg. The study was conducted for 16 weeks and showed a significant beneficial effect on symptoms of hyperactivity or attention deficit hyperactivity disorder (ADHD) and on cognitive improvement.18

Effect in Parkinson's disease

The effect of bacopa extract was tested on different animal models. An alcoholic extract in which the main active ingredients were bacosides was investigated on the nematode model Caenorhabditis elegans. Application of the extract has been shown to reduce the aggregation of α-synuclein, a key protein that leads to the degeneration of nerve cells. This prevents dopaminergic neurodegeneration and enables the restoration of nematode lipids.19

A study on mice showed that bacopa extract offers a dopaminergic neuroprotective effect by modulating oxidative stress and apoptotic mechanisms.20 Another study was conducted by treating mice suffering from Parkinson's disease with bacopa extract or mucuna extract. The one­ month treatment significantly reduced the elevated levels of oxidative stress. In behavioral tests, a comparative analysis of bacopa extract and mucuna extract showed a significant increase in spontaneous locomotor activity and the grip strength test. It was found that the use of bacopa extract significantly improved the activity of tyrosine hydroxylase, caspase­3 and the expression of a neurogenic gene in the brain area ­ substantia nigra. 21 All these results are certainly in favor of bacopa as a potentially beneficial plant for treating and alleviating the symptoms of Parkinson's disease.

Effect in Alzheimer's disease

The effect of bacopa extract in patients with Alzheimer's disease was tested using different models. An in silico study examined the effects of two bacopa saponins, bacosaponin G and bacosaponin N2, in comparison to donepezil, a drug commonly used in the treatment of Alzheimer's disease. The study showed that bacosaponins have a more favorable binding affinity for therapeutic targets in Alzheimer's disease, specifically for caspase-3 and tau protein kinase I receptors. 22 The results of that research point to the excellent potential of bacopa.

A study was also conducted that compared the effects of herbal therapy (a combination of Bacopamonnieri, Hippophae rhamnoides and Dioscorea bulbifera) in patients suffering from Alzheimer's disease compared to donepezil therapy. Two groups of subjects were included in the study, which lasted 12 months: a group of patients (aged 60 to 75) and a group of healthy subjects. The study, comparing herbal therapy and placebo, observed a significant improvement in the results of neuropsychological tests such as the mini mental state test, digital symbol substitution, results of delayed word recall, attention span, frequently asked questions and depression scores in healthy patients.

In patients with Alzheimer's disease, improvement was comparable to that achieved with donepezil in the Mini Mental State Test, Dementia Screening Scale, Immediate Word Recall, Delayed Word Recall, Attention Span, Frequently Asked Questions, and Depression Score. 23

Another study on patients with Alzheimer's disease examined the effect of bacopa in a daily dose of 600 mg for 6 months. The study revealed a statistically significant increase in performance in various aspects of mental state tests, and concluded that B. monnieri is beneficial in patients with Alzheimer's disease. 24

Regulation and labeling

In Croatia, the plant species Bacopa monnieri is on the list of permitted plant species that can be used in formulating food supplements. When labeling the product, it is necessary to state that people who take medication should consult a doctor before taking a product containing bacopa, and that the use is not recommended for thyroid diseases, asthma, emphysema, disorders of the digestive and urinary systems, heart disorders, pregnant women, nursing mothers and to children.

In other countries of the European Union, such as Italy, France, Belgium and the Czech Republic, bacopa is also on the list of permitted plant species, but no special notes are required when labeling.

Conclusion

All available studies are certainly in favor of the use of bacopa in individuals with difficulties and illnesses, but also in healthy patients who are in states of mental effort. Of particular interest is the wide range of possible patient ages, from the pediatric to the geriatric population. Although bacopa is still a lesser-known plant species in our area, considering the specific effects it shows in the field of cognitive health and functioning, we can conclude that it will surely become recognized in professional circles and among patients.

References:

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