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Paullinia Cupana) Supplementation on the Cognitive Performance of Young Healthy Adults – a Systematic Review

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Paullinia Cupana) Supplementation on the Cognitive Performance of Young Healthy Adults – a Systematic Review GLOBAL PSYCHIATRY — Vol 2 | Issue 2 | 2019 Fanaras Konstantinos1, Reinhard Heun2 The effects of Guarana (Paullinia cupana) supplementation on the cognitive performance of young healthy adults – a Systematic Review. 1Undergraduate student of medicine at Aristotle University of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece 2Professor of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany *emails: [email protected] DOI: 10.2478/gp-2019-0015 Received: 17 April 2019; Accepted: 17 July 2019 Abstract OBJECTIVES: Guarana (Paullinia cupana) from the Sapindaceae family, native to the Amazon basin, is a natural stimulant herb that can be found in popular energy drinks, pharmaceutical shops or local herb shops. With the use of natural health products increasing, guarana has gained a fair amount of popularity in the past years. In this systematic review, we examined the effects of guarana supplementation on cognitive performance. A secondary objective was to compare guarana with caffeine on cognitive performance. METHODS: Searches were made in PubMed using the terms ‘Guarana’ or ‘Paullinia cupana’. Filters focused on Controlled Clinical trials. Inclusion criteria were met by studies using interventions with guarana, while focusing on guarana’s effects on cognition. Participants needed to be young, healthy adults. Studies not published in English or Greek were excluded. The last date of our search was March 7, 2019. RESULTS: A total of 29 studies were identified and screened. After screening, 17 studies were excluded. The remaining 12 studies were found eligible for data extraction. After reading the full text of the 12 studies, 3 studies were excluded. In the end, 9 studies were found eligible for our systematic review (n = 369 participants). In these studies, guarana showed to improve reaction time and accuracy of performance at cognitive tasks. No significant differences were found when comparing guarana with caffeine. CONCLUSION: Guarana seems to improve reaction time and accuracy of performance at tasks, but no significant effects were found when compared with caffeine. High quality randomized controlled clinical trials with a low risk of bias are needed to further study the herb. Keywords Guarana, Paullinia Cupana, Caffeine, Cognition, Nootropics, Herbal Medicine, Systematic Review INTRODUCTION the hormone adrenaline. In the central nervous system, most stimulants interfere with the neurotransmitters norepinephrine, Cognition and Cognitive Enhancing Substances dopamine, glutamate or serotonin, increasing the activity of their circuits (Rang et al., 2012). Cognition is ‘the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses’ Substances that are used to improve cognitive function in (Oxford Dictionary). Cognitive skills are perception, memory, healthy individuals are named nootropics (Frati et al., 2015). language, attention, executive functions, psychomotor functions, Nootropics act as direct or indirect agonists of dopamine information processing, applying knowledge and changing receptor D1, adrenoceptor A2 or both types of receptors in preferences (Froestl W, Muhs A, Pfeifer A, 2014). the prefrontal cortex (Spencer, Devilbiss and Berridge, 2015), as vasodilators increasing blood flow to the brain, or by Most cognitive enhancing substances, in general, are stimulants increasing glutaminergic neurotransmission (Noor Azuin of the nervous system. Stimulants are known to increase Suliman et al., 2016). The most common nootropics are physical and mental performance. They may interfere with amphetamines (Wood et al., 2014) methylphenidate (Wood et the central nervous system or the peripheral nervous system. al., 2014) eugeroics (modafinil, armodafinil) (Bagot, Kaminer, In the peripheral nervous system, stimulants increase the 2014) nicotine (Heishman, Kleykamp and Singleton, 2010) and action of the sympathetic nervous system via stimulation of caffeine (Wood et al., 2014). OR © 2019 Fanaras Konstantinos, Dr. Reinhard Heun. This is an open access article licensed under the Creative 171 Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/3.0/). GLOBAL PSYCHIATRY — Guarana supplementation on cognitive function Numerous cognitive tests are available for the assessment of cognitive and physical enhancing properties. It is brewed in tea, cognition. However, with the completion of this systematic eaten raw or supplemented in capsules. Also, it has become a review, we have encountered great heterogeneity of cognitive very popular ingredient of mainstream energy drinks (van den tests across studies. In order to perform a meta-analysis of the Eynde et al., 2008). It is usually found at low concentrations outcome results, such heterogeneity must be eliminated. Thus, in energy drinks and is thought to enhance the stimulating we propose the CDR computerized assessment system (Keith properties of caffeine. A. Wesnes, 2000) for the evaluation of the effects of guarana on cognition accompanied by the Serial of 3s and Serial of 7s tasks. Studies made on guarana show that the herb improves decision- The CDR battery has been found sensitive for the assessment of making performance (Pomportes et al., 2014), temporal the cognitive effects of herbal extracts and can be used to both performance (Pomportes et al., 2017), task performance mentally impaired and healthy participants (Kennedy, 2004). (Kennedy et al., 2004), working memory and attentional The tests included in the CDR battery system are immediate/ processing (Scholey et al., 2013). Promising effects in some delayed word recall, word recognition, picture recognition, cognitive domains were found by Haskell et al. (2007), Kennedy simple reaction time, digit vigilance, choice reaction time, et al. (2004), Scholey et al. (2013) and Nehlig (2010). numeric working memory and spatial working memory. The measurements of the single tests of the battery are combined We decided to perform this systematic review on guarana into five cognitive outcome factors: ‘Speed of Attention’ factor, because of the increasing popularity of the herb. Guarana has ‘Speed of Memory’ factor, ‘Accuracy of Attention’ factor, been used for centuries in Latin America. In the modern age, ‘Secondary Memory’ factor and ‘Working Memory’ factor. the introduction of energy drinks and the trend of society The battery may be accompanied with other cognitive tests, towards Natural Health Products (NHPs), has boosted the such as the Serial of 7s or Serial of 3s. The Serial of 7s test was worldwide market of guarana (Future Market Insights, 2016). proposed in 1942 Hayman and has been used for decades for A herb that was once used by indigenous tribes in the Amazon the evaluation of memory and concentration by neurologists has now found it‘s way into local herb shops, popular energy and psychiatrists. The simplicity of the test and its diachronic drinks and pharmaceutical shops. In this review, we examine use make it a great supplementary cognitive test next to the the effects of guarana (Paullinia cupana) on cognition. A CDR battery. secondary objective is to compare guarana with caffeine on cognitive performance. Such a comparison aims to evaluate Guarana the role of different compounds found in guarana and their possible synergy with guaranine. Guarana (Paullinia cupana) is a plant that is very common in Latin America and is widely used in Brazil. the plant‘s seeds METHODS are about the size of coffee beans. Guarana beans contain about double the concentration of caffeine found in coffee beans Type of Study (3.6–5.8% caffeine, compared to 1–2% found in coffee beans) (WebMD 2017). The study was a systematic review. Searches were made in PubMed. Search terms were ‘Guarana’ or ‘Paullinia cupana’. The caffeine found in guarana, is named ‘guaranine’. Guaranine The PubMed filter was customized to ‘Controlled Clinical is a synonym of caffeine (Liguori, Hughes, Grass, 1997). Trial’. The search was performed according to the Preferred Guarana plants contain guaranine, as a defense mechanism Reporting Items for Systematic Reviews and Meta-Analysis against herbivore animals (Nathanson JA, 1984). Other than (PRISMA criteria; Moher D et al., 2009). The last date of our guaranine, guarana contains theophylline and theobromine search was March 7, 2019. (Espinola et al., 1997), as well as tannins, catechins, epicatechins (Haskell et al., 2006), which may contribute to a different Study Selection behavioural effect from caffeine (Duchan, Patel, 2010). We selected studies using the following inclusion criteria: Guarana has been used for centuries in North America and a) The study must use an intervention containing guarana. the Amazon (Henman, 1982; as cited by Haskell et al., 2006) as b) The study must examine the effects of the guarana a stimulant and a nootropic. Native tribes have used the herb intervention on cognition. as an aphrodisiac, as an energy and endurance booster and as c) The population must be young adults. Young adults were a wakefulness agent. In modern days, guarana is used for it‘s defined as those who were younger than 45 years old. This 172 173 GLOBAL PSYCHIATRY — Vol 2 | Issue 2 | 2019 PRISMA Flowgraph Methods & Results of PubMed Database Search RECORDS IDENTIFIED THROUGH ADDITIONAL RECORDS IDENTIFIED THROUGH DATABASE SEARCHING: n=29 OTHER DATABASE SOURCES: n=0 IDENTIFICATION RECORDS AFTER DUPLICATES REMOVED: n=29 RECORDS SCREENED: n=29 RECORDS EXCLUDED: n=17 SCREENING FULL - TEXT ARTICLES
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