Skip to main content
SpringerLink
Log in

Can Valeriana officinalis root extract prevent early postoperative cognitive dysfunction after CABG surgery? A randomized, double-blind, placebo-controlled trial

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Rationale

We hypothesized that valerian root might prevent cognitive dysfunction in coronary artery bypass graft (CABG) surgery patients through stimulating serotonin receptors and anti-inflammatory activity.

Objectives

The aim of this study was to evaluate the effect of Valeriana officinalis root extract on prevention of early postoperative cognitive dysfunction after on-pump CABG surgery.

Methods

In a randomized, double-blind, placebo-controlled trial, 61 patients, aged between 30 and 70 years, scheduled for elective CABG surgery using cardiopulmonary bypass (CPB), were recruited into the study. Patients were randomly divided into two groups who received either one valerian capsule containing 530 mg of valerian root extract (1,060 mg/daily) or placebo capsule each 12 h for 8 weeks, respectively. For all patients, cognitive brain function was evaluated before the surgery and at 10-day and 2-month follow-up by Mini Mental State Examination (MMSE) test.

Results

Mean MMSE score decreased from 27.03 ± 2.02 in the preoperative period to 26.52 ± 1.82 at the 10th day and then increased to 27.45 ± 1.36 at the 60th day in the valerian group. Conversely, its variation was reduced significantly after 60 days in the placebo group, 27.37 ± 1.87 at the baseline to 24 ± 1.91 at the 10th day, and consequently slightly increased to 24.83 ± 1.66 at the 60th day. Valerian prophylaxis reduced odds of cognitive dysfunction compared to placebo group (OR = 0.108, 95 % CI 0.022–0.545).

Conclusion

We concluded that, based on this study, the cognitive state of patients in the valerian group was better than that in the placebo group after CABG; therefore, it seems that the use of V. officinalis root extract may prevent early postoperative cognitive dysfunction after on-pump CABG surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Arrowsmith JE, Grocott HP, Reves JG, Newman MF (2000) Central nervous system complications of cardiac surgery. Br J Anaesth 84:378–393

    Article  CAS  PubMed  Google Scholar 

  • Baumgartner WA (2007) Neurocognitive changes after coronary bypass surgery. Circulation 116:1879–1881

    Article  PubMed  Google Scholar 

  • Bcpp CGP, Boustani MA, Ayub A, Munger SL, Farber M, Ademuyiwa A, Singh R (2009) Pharmacological management of delirium in hospitalized adult: a systematic evidence review. J Gen Intern Med 24:848–853

    Article  Google Scholar 

  • Bent S, Padula A, Moore D, Patterson M, Mehling W (2006) Valerian for sleep: a systematic review and meta-analysis. Am J Med 119:1005–1012

    Article  PubMed  Google Scholar 

  • Bilotta F, Doronzio A, Stazi E, Titi L, Zeppa IO, Cianchi A, Rosa G, Paoloni FP, Bergese S, Asouhidou I (2011) Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial-The PINOCCHIO trial. Trials 12:170

    Article  PubMed Central  PubMed  Google Scholar 

  • Circosta C, De Pasquale R, Samperi S, Pino A, Occhiuto F (2007) Biological and analytical characterization of two extracts from Valeriana officinalis. J Ethnopharmacol 112:361–367

    Article  CAS  PubMed  Google Scholar 

  • Dietz BM, Mahady GB, Pauli GF, Farnsworth NR (2005) Valerian extract and valerenic acid are partial agonists of the 5-HT5a receptor in vitro. Mol Brain Res 138:191–197

    Article  CAS  PubMed  Google Scholar 

  • Farhoudi M, Mehrvar K, Afrasiabi A, Parvizi R, Khalili AA, Nasiri B, Hashemzadeh K, Ghabili K (2010) Neurocognitive impairment after off-pump and on-pump coronary artery bypass graft surgery: an Iranian experience. Neuropsychiatr Dis Treat 6:775

    PubMed Central  PubMed  Google Scholar 

  • Figueroa-Ramos MI, Arroyo-Novoa CM, Lee KA, Padilla G, Puntillo KA (2009) Sleep and delirium in ICU patients: a review of mechanisms and manifestations. Intensive Care Med 35:781–795

    Article  PubMed  Google Scholar 

  • Fulda S, Schulz H (2001) Cognitive dysfunction in sleep disorders. Sleep Med Rev 5:423–445

    Article  PubMed  Google Scholar 

  • Gamberini M, Bolliger D, Buse GAL, Burkhart CS, Grapow M, Gagneux A, Filipovic M, Seeberger MD, Pargger H, Siegemund M (2009) Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery-a randomized controlled trial*. Crit Care Med 37:1762–1768

    Article  CAS  PubMed  Google Scholar 

  • Ghafari R, Gholipour Baradari G, Firouzian A, Nouraei M, Aarabi M, Zamani A, Emami Zeydi A (2012) Cognitive deficit in first-time coronary artery bypass graft patients: a randomized clinical trial of lidocaine versus procaine hydrochloride. Perfusion 27:320–325

  • Gilmore ML, Wolfe DJ (2013) Antipsychotic prophylaxis in surgical patients modestly decreases delirium incidence—but not duration—in high-incidence samples: a meta-analysis. Gen Hosp Psychiatry 35:370–375

    Article  PubMed  Google Scholar 

  • Gooneratne NS (2008) Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med 24:121–138

    Article  PubMed Central  PubMed  Google Scholar 

  • Gorelick PB (2010) Role of inflammation in cognitive impairment: results of observational epidemiological studies and clinical trials. Ann N Y Acad Sci 1207:155–162

    Article  PubMed  Google Scholar 

  • Inouye SK, Bogardus ST Jr, Charpentier PA, Leo-Summers L, Acampora D, Holford TR, Cooney LM Jr (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676

    Article  CAS  PubMed  Google Scholar 

  • Jacobo-Herrera NJ, Vartiainen N, Bremner P, Gibbons S, Koistinaho J, Heinrich M (2006) NF-κB modulators from Valeriana officinalis. Phytother Res 20:917–919

    Article  CAS  PubMed  Google Scholar 

  • Kalisvaart KJ, De Jonghe JFM, Bogaards MJ, Vreeswijk R, Egberts TCG, Burger BJ, Eikelenboom P, Van Gool WA (2005) Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study. J Am Geriatr Soc 53:1658–1666

    Article  PubMed  Google Scholar 

  • Kilo J, Czerny M, Gorlitzer M, Zimpfer D, Baumer H, Wolner E, Grimm M (2001) Cardiopulmonary bypass affects cognitive brain function after coronary artery bypass grafting. Ann Thorac Surg 72:1926–1932

    Article  CAS  PubMed  Google Scholar 

  • Mungas D (1991) In-office mental status testing: a practical guide. Geriatrics 46:54–58, 63, 66

    CAS  PubMed  Google Scholar 

  • Murti K, Kaushik M, Sangwan Y, Kaushik A (2011) Pharmacological properties of Valeriana officinalis—a review. Pharmacol 3:641–646

    Google Scholar 

  • Nam SM, Choi JH, Yoo DY, Kim W, Jung HY, Kim JW, Kang S-Y, Park J, Kim D-W, Kim WJ (2013) Valeriana officinalis extract and its main component, valerenic acid, ameliorate D-galactose-induced reductions in memory, cell proliferation, and neuroblast differentiation by reducing corticosterone levels and lipid peroxidation. Exp Gerontol 48:1369–1377

    Article  CAS  PubMed  Google Scholar 

  • Oldenbeuving AW, de Kort PLM, Jansen BPW, Kappelle LJ, Roks G (2008) A pilot study of rivastigmine in the treatment of delirium after stroke: a safe alternative. BMC Neurol 8:34

    Article  PubMed Central  PubMed  Google Scholar 

  • Patočka J, Jakl J (2010) Biomedically relevant chemical constituents of Valeriana officinalis. J Appl Biomed 8:11–18

    Article  Google Scholar 

  • Peng L, Xu L, Ouyang W (2013) Role of peripheral inflammatory markers in postoperative cognitive dysfunction (POCD): a meta-analysis. PLoS One 8:e79624

    Article  PubMed Central  PubMed  Google Scholar 

  • Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST (2001) Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review) report of the quality standards subcommittee of the American academy of neurology. Neurology 56:1133–1142

    Article  CAS  PubMed  Google Scholar 

  • Pisani MA, Murphy TE, Araujo KLB, Van Ness PH (2010) Factors associated with persistent delirium after intensive care unit admission in an older medical patient population. J Crit Care 25:540. e1–540. e7

    Article  Google Scholar 

  • Plaschke K, Fichtenkamm P, Schramm C, Hauth S, Martin E, Verch M, Karck M, Jr K (2010) Early postoperative delirium after open-heart cardiac surgery is associated with decreased bispectral EEG and increased cortisol and interleukin-6. Intensive Care Med 36:2081–2089

    Article  CAS  PubMed  Google Scholar 

  • Rudolph JL, Jones RN, Grande LJ, Milberg WP, King EG, Lipsitz LA, Levkoff SE, Marcantonio ER (2006) Impaired executive function is associated with delirium after coronary artery bypass graft surgery. J Am Geriatr Soc 54:937–941

    Article  PubMed Central  PubMed  Google Scholar 

  • Sampson EL, Raven PR, Ndhlovu PN, Vallance A, Garlick N, Watts J, Blanchard MR, Bruce A, Blizard R, Ritchie CW (2007) A randomized, double-blind, placebo-controlled trial of donepezil hydrochloride (Aricept) for reducing the incidence of postoperative delirium after elective total hip replacement. Int J Geriatr Psychopharmacol 22:343–349

    Article  Google Scholar 

  • Scott DA, Evered LA, Silbert BS (2014) Cardiac surgery, the brain, and inflammation. J Extra Corp Technol 46:15–22

    Google Scholar 

  • Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, Rodriguez AL, Magovern CJ, Zaubler T, Freundlich K (2009) Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg 87:36–45

    Article  PubMed  Google Scholar 

  • Spiegel DR, Ahlers D, Yoder G, Qureshi N (2011) Atypical antipsychotics for delirium: a reasonable alternative to haloperidol? Curr Psychiatr 10:37

    Google Scholar 

  • Sudati JH, Vieira FA, Pavin SS, Dias GRM, Seeger RL, Golombieski R, Athayde ML, Soares FA, Rocha JBT, Barbosa NV (2013) Valeriana officinalis attenuates the rotenone-induced toxicity in Drosophila melanogaster. Neurotoxicology 37:118–126

    Article  CAS  PubMed  Google Scholar 

  • Sudati JH, Fachinetto R, Pereira RP, Boligon AA, Athayde ML, Soares FA, de Vargas Barbosa NB, Rocha JBT (2009) In vitro antioxidant activity of Valeriana officinalis against different neurotoxic agents. Neurochem Res 34:1372–1379

    Article  CAS  PubMed  Google Scholar 

  • Sveinsson IS (1975) Postoperative psychosis after heart surgery. J Thorac Cardiovasc Surg 70:717–726

    CAS  PubMed  Google Scholar 

  • Taavoni S, Ekbatani N, Kashaniyan M, Haghani H (2011) Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause 18:951–955

    Article  PubMed  Google Scholar 

  • Taibi DM, Vitiello MV, Barsness S, Elmer GW, Anderson GD, Landis CA (2009) A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia. Sleep Med 10:319–328

    Article  PubMed Central  PubMed  Google Scholar 

  • Van Harten AE, Scheeren TWL, Absalom AR (2012) A review of postoperative cognitive dysfunction and neuroinflammation associated with cardiac surgery and anaesthesia. Anaesthesia 67:280–293

    Article  PubMed  Google Scholar 

  • Wang Q, Wang C, Shu Z, Chan K, Huang S, Li Y, Xiao Y, Wu L, Kuang H, Sun X (2014) Valeriana amurensis improves Amyloid-beta 1-42 induced cognitive deficit by enhancing cerebral cholinergic function and protecting the brain neurons from apoptosis in mice. J Ethnopharmacol 153:318–325

    Article  CAS  PubMed  Google Scholar 

  • Yildizeli B, Oğuzhan Özyurtkan M, Batirel HF, Kuscu K, Bekiroglu N, Yuksel M (2005) Factors associated with postoperative delirium after thoracic surgery. Ann Thorac Surg 79:1004–1009

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank the staff of Mazandaran Heart Center, Mazandaran, Sari, Iran, and the patients at the Fatemeh Zahra Hospital, Division of Cardiac Surgery, and ICU Open Heart for their kind and efficient collaboration. The financial support of Research Deputy of Islamic Azad University is gratefully acknowledged. We are grateful to Dr. Farzaneh Tabassomi for doing neurocognitive test.

Conflict of interest

All authors declare no conflicts of interest; no conflict of interest exists for any of the authors associated with the manuscript and there was no source of extra institutional commercial funding, and the entire study was performed without external funding. The funding organization had no role in the design and conduct of the study, and in the collection, analysis, and interpretation of the data.

Author information

Authors and Affiliations

  1. Department of Nursing, Faculty of Medicine, Islamic Azad University, 7th km of Sea Road (Farah Abaad), Firoozkande, Sari, Iran

    Soghra Hassani, Hadi Darvishi Khezri & Homeyra Tahmasebi

  2. Department of Epidemiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Abbas Alipour

  3. Department of Anesthesiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Abolfazl Firouzian & Afshin Gholipour Baradari

  4. Department of Nursing, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran

    Amir Emami Zeydi

  5. PhD Student in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

    Amir Emami Zeydi

  6. Department of Cardiac Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Rahman Ghafari & Wali-allah Habibi

  7. ICU, Mazandaran University of Medical Sciences, Sari, Iran

    Fatemeh Alipour & Pooneh Ebrahim Zadeh

Authors
  1. Soghra Hassani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abbas Alipour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hadi Darvishi Khezri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abolfazl Firouzian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amir Emami Zeydi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Afshin Gholipour Baradari
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rahman Ghafari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wali-allah Habibi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Homeyra Tahmasebi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fatemeh Alipour
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Pooneh Ebrahim Zadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hadi Darvishi Khezri.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hassani, S., Alipour, A., Darvishi Khezri, H. et al. Can Valeriana officinalis root extract prevent early postoperative cognitive dysfunction after CABG surgery? A randomized, double-blind, placebo-controlled trial. Psychopharmacology 232, 843–850 (2015). https://doi.org/10.1007/s00213-014-3716-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-014-3716-x

Keywords

Search

Navigation