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Geriforte in Neurological Disorders

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  • 1. [Probe (1980): (XX), 1, 13-17] Geriforte in Neurological Disorders Velmurugendran, C.U., M.D., D.M. (Neurology), Professor and Neurologist and Virudhagirinatha, B.S., M.A., Clinical Neuropsychologist, Department of Medical Neurology, Stanley Medical College and Government Stanley Hospital, Madras, India. The physical and mental fitness of an individual depends largely on healthy tissues, which in turn are responsible for proper physiological functioning. Geriforte is reported to improve the sense of well-being by promoting a feeling of physical energy and mental competence for performing routine work. Geriforte is reported to arrest degenerative changes and accelerate cellular regeneration and repair and also to improve hormone utilization. It tones up the heart, improves circulation, and reduces levels of serum cholesterol and other lipids. It increases physical capacity, raises the threshold of fatiguability, improves mental acuity and activates the nervous system. The adaptogenic properties of Geriforte induce better stress tolerance by correcting the level of neurohumours, improve the endocrine function and protein metabolism. In the present study, the clinical effects on the endocrine, neurohumoral and metabolic function will be studied by administering Geriforte, an indigenous compound containing various reputed ingredients having various reconstituents, tonics and hepatic stimulants. Each Geriforte tablet contains: Chyavanprash concentrate 100 mg Exts. Capparis spinosa 13.8 mg Cichorium intybus 13.8 mg Solanum nigrum 6.4 mg Cassia occidentalis 3.2 mg Terminalia arjuna 6.4 mg Achillea millefolium 3.2 mg Tamarix gallica 3.2 mg Mandur bhasma 5 mg Saffron 5 mg Amber 2 mg Makardhwaj 10 mg Asparagus adscendens 10 mg Caesalpinia digyna 10 mg Asparagus racemosus 20 mg Withania somnifera 30 mg Glycyrrhiza glabra 20 mg Centella asiatica 20 mg Shilajeet (Purified) 20 mg Terminalia chebula 15 mg Mucuna pruriens 10 mg Myristica fragrans 10 mg Piper longum 10 mg Mace 10 mg Eugenia caryophyllata 5 mg Elettaria cardamomum 5 mg Carum copticum 5 mg Curcuma longa 5 mg Exts. Berberis aristata 10 mg Adhatoda vasica 10 mg Eclipta alba 10 mg Celastrus paniculatus 5 mg Argyreia speciosa 10 mg Abhrak bhasma 10 mg Loh bhasma 5 mg Jasad bhasma 10 mg Processed in Phyllanthus emblica, Terminalia chebula, Eclipta alba, Asparagus racemosus, Allium cepa, Allium sativum, Phyllanthus niruri, Boerhaavia diffusa, Tinospora, cordifolia, Berberis aristata, Raphanus sativus, Tribulus terrestris, Dashamoola.
  • 2. As Geriforte enhances mental acuity of the individual and improves the general health, it has been chosen for clinical study. MATERIAL AND METHODS Seventy patients were selected from the Department of Medical Neurology, Stanley Medical College and Government Stanley Hospital, Madras. They were divided into the following four groups: Group I : Cases with pure cerebroneurological lesion. Group II : Cases with peripheral lesion. Group III: Cases with minimal symptoms. Group IV: Cases with dementia. Table I: Age distribution in each group No. of cases in each group Age in years I II III IV 10-15 3 – 3 – 16-20 6 1 5 2 21-30 6 – 8 4 31-40 7 2 – 2 41-50 1 – 3 2 51-60 3 – 1 6 Over 61 – 1 4 – Total 26 4 24 16 Group I consisted of patients who had cerebral lesions such as epilepsy, meningitis, stroke, degenerative disease, mental retardation and extrapyramidal disorder. Group II consisted of patients who had lesions such as peripheral neuritis, anterior horn cell disorder etc. Group III consisted of patients who had symptoms like headache, loss of memory, inability to concentrate etc. This Group also included apparently normal persons and others who volunteered for enhancing their mental capability. Group IV consisted of those with dementia and were being treated at the mental hospital. There were 26 cases in Group I, 4 cases in Group II, 24 cases in Group III and remaining 16 were in Group IV. The age group of the patients was 10 to 70 years. Groups I, II and III were examined completely, a thorough neurological examination was made. Appropriate investigations such as blood examinations, skull X-rays, EEG and EMG studies were also carried out. They were tested by a competent neuro-psychologist and they were assessed for the following neuro-psychological functions namely (1) attention and concentration (2) memory (3) intelligence (4) immediate memory (5) retention (6) visuomotor co-ordination and visual recalls. Attention and concentration were assessed by the Knox-Cuba Test. Intelligence was measured by Bhatia's battery of performance tests of intelligence (Short Scale). Memory was evaluated by Wechsley Memory Scale Form I. Perceptomotor function was assessed by Bender Visual Motor Gestalt Test. All these are standardised tests. Personality tests such as Rorschach Ink-Blot Test and Eysenck Personality Inventory were given to six patients who had personality problems.
  • 3. Neuropsychological changes in the mild group were observed for a period of one year in these cases. Table II: Pure neurological deficit group – initial findings Symptoms Normal Below normal Attention and concentration 1 24 Memory 2 23 Immediate memory 2 24 Retention 1 24 Intelligence 6 19 Visuomotor concentration 13 10 Visual recall 5 18 OBSERVATIONS Pure Neurological Deficit Group In the pure neurological deficit group, Group I there were 26 cases. Two patients could not be tested due to hemiplegia. They were followed-up for one month, three months and six months. Eight patients were subjected to psychological testing at the end of one and three months, and six at the end of 6 months. Attention and concentration improved in 2 at the end of one month, in one at the end of 3 months and three out of 6 at the end of six months. Memory improved in one case at the end of one month, three at the end of three months and three out of six in six months. Regarding immediate memory, one case improved at the end of one month, three at the end of three months and four out of six at the end of six months. In one patient, retention was found improved at the end of three months and six months. Intelligence improved in one case at the end of one month and in another case at the end of six months. Visuomotor co-ordination improved in one case at the end of one month, in two cases at the end of three months and in four cases out of six at the end of six months. Visual recall improved in two cases each at the end of one month, three months and six months. Some cases remained unchanged but none deteriorated at the end of one month, three months and six months on Geriforte. Peripheral Lesion Group Four cases came under Group II for study of neuropsychological changes in the peripheral type of disease. All of them exhibited abnormality in attention and concentration, immediate memory, intelligence and visual recall. The next affected function was memory. The next affected function was memory. Two patients reported for review at the end of one month. Memory, visual recall and retention were found improved. The rest of the functions remained unchanged. One patient of peripheral neuropathy and pain showed improvement at the end of three months. Even though the sample is small, the results on follow-up are decidedly very encouraging. Table III: Initial examination – minimal symptom group Psychological function Normal % Below Normal % Attention and concentration – – 24 (100.0) Memory 18 (75) 6 (25.0) Immediate memory 13 (54.2) 11 (45.8) Retention 6 (25) 18 (75.0) Intelligence 14 (58.3) 10 (41.7) Visuomotor concentration 22 (91.2) 2 ( 8.8) Visual recall 7 (29.2) 17 (70.8)
  • 4. Minimal Symptom Group In Group III, the minimal symptom group, the neuropsychological changes were as follows: At the initial assessment, all the 24 cases exhibited below normal level of attention and concentration. The next most disturbed functions were retention and visual recall. Subnormal memory and intellectual level were seen in 11 and 10 cases respectively. The least affected function was visuomotor co-ordination. Fourteen patients reported for follow-up at the end of one month. 9 patients showed improvement in attention and concentration; five cases exhibited improvement in immediate memory and retention capacity. Visual recall improved in 3 cases, memory in 2 cases and visuomotor co-ordination in one case. None of the patients showed deterioration. Seven patients reported for the third monthly follow-up testing. Improvement in immediate memory was seen in all the seven cases, improvement in attention and concentration in six cases, visual recall in 5 cases and improvement in retention and intelligence in 4 cases. Immediate memory and retention and concentration were recovered fully. None showed deterioration. Five patients reported at the end of six months. All of them showed improvement in attention and concentration. Improvement in memory and visual recall improved in four cases, retention capacity improved in three cases. Intelligence and visuomotor co-ordination remained unchanged. None of the patients showed any deterioration. Two patients had reported for the testing at the end of one year, both showed considerable improvement in attention and concentration, memory, immediate memory, retention and visual recall. Intellectual function remained the same in these cases. One case showed improvement in visuomotor co-ordination. Dementia Group In Group IV with dementia, none of the patients deteriorated (though in their natural course they usually tend to deteriorate) even at the end of one year while on observations and study. DISCUSSION In this study since a majority of the patients complained of poor immediate memory, difficulty in retention and recall, these functions were quantitatively studied. The most affected functions at the time of initial testing in all the three groups were attention, concentration and memory. Visuomotor co-ordination was the least affected. None of the patients with dementia in Group IV deteriorated at the end of one year. Of course, improvement is ordinarily not expected in this group, as they usually deteriorate. None of the cases in any of the groups (including dementia, Group IV) showed even a slight degree of deterioration in neuropsychological status after the administration of Geriforte. All the patients showed a sense of well-being. Attention, concentration, immediate memory and retention improved in all the first three groups. All the neuropsychological symptoms improved in Group III and one patient in the peripheral type showed total relief from his complaints and improvement in psychological status. In conclusion, we might observe that Geriforte has shown good neuropsychological improvements and a sense of well-being in all the patients when compared with the other drugs employed for the same indications. It is also economical. There were no toxic or side effects. This preliminary study has proved very stimulating, as the results are very encouraging. These conditions need closer study particularly by the double blind method. Geriforte seems to have a definite place in the management
  • 5. of neuropsychological complaints as listed above and is well worth a trial in order to provide relief to patients in all the grades of neuromedical disorders. SUMMARY 1. Geriforte tablets 1 t.i.d. initially and 2 t.i.d. daily for one year were given to patients with different neurological symptoms. 2. The patients were grouped into pure cerebral damage (26 patients), peripheral neurological damage (4 patients), minimal symptoms (24 patients) and dementia group (16 patients). 3. The response to attention and concentration, memory, immediate memory, retention, intelligence, visuomotor co-ordination and visual recall were studied. 4. All the patients showed good psychological improvement and a sense of well-being. 5. The dementia group did not show deterioration, even at the end of one year. 6. The drug is safe on prolonged use and there were no untoward side effects.