The Changes of Cortical Metabolism Associated With the Clinical Response to Donepezil Therapy in Traumatic Brain Injury
ABSTRACT To determine the effects of treatment with donepezil on cortical metabolism in patients with traumatic brain injury using F-fluorodeoxyglucose positron emission tomography.
Twenty-six patients with cognitive impairment after traumatic brain injury were enrolled and randomly assigned into the donepezil-treated group and the control group. There was no significant difference between 2 groups in age, sex, education, and postinjury duration. Donepezil 5 mg was administered daily for 3 weeks and then 10 mg/d for 3 weeks to patients in the experimental groups. For both groups, we evaluated cognitive function with Mini-Mental State Examination, Wechsler Memory Test, Boston Naming Test, Colored Progressive Matrices upon initial evaluation and at the 6-week follow-up. An 18F-fluorodeoxyglucose positron emission tomography of the brain was performed before and after 6 weeks of the donepezil-treated group. Effects of donepezil treatment on cortical metabolism were analyzed using Statistical Parametric Mapping software (Institute of Neurology, University College London, UK).
There was no significance difference between the 2 groups in initial evaluation of cognitive functions. After 6 weeks, compared with the control group, donepezil-treated group showed enhanced cognitive functions (P < 0.05), and 18F-fluorodeoxyglucose positron emission tomography showed a statistically significant increase in the cerebral cortical metabolism for both of the frontal, parietal, occipital, and temporal cortices (P < 0.01) which are the key role of attention and object naming.
Cholinergic augmentation by donepezil therapy in traumatic brain injury shows a cortical metabolic effect on the both of the frontal, parietal, occipital, and temporal cortices associated with clinical response to treatment.
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ABSTRACT: Tesis Univ. Granada. Departamento de Radiología y Medicina Física. Leída el 12 de julio de 2010
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ABSTRACT: Psychiatrists are increasingly called upon to care for individuals with cognitive, emotional, and behavioral disturbances after TBI, especially in settings serving military service personnel and Veterans. In both the early and late post-injury periods, cognitive impairments contribute to disability among persons with TBI and are potentially substantial sources of suffering for persons with TBI and their families. In this article, the differential diagnosis, evaluation, and management of posttraumatic cognitive complaints is reviewed. The importance of pre-treatment evaluation as well as consideration of non-cognitive contributors to cognitive problems and functional limitations is emphasized first. The course of recovery after TBI, framed as a progression through posttraumatic encephalopathy, is reviewed next and used to anchor the evaluation and treatment of posttraumatic cognitive impairments in relation to injury severity as well as time post-injury. Finally, pharmacologic and rehabilitative interventions that may facilitate cognitive and functional recovery at each stage of posttraumatic encephalopathy are presented.Psychiatric Annals 11/2010; 40(11):540-552. DOI:10.3928/00485713-20101022-05 · 0.71 Impact Factor
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ABSTRACT: Pharmacological treatments that are administered to adults in the postacute stage after a traumatic brain injury (TBI) (≥4 weeks after injury) have the potential to reduce persistent cognitive and behavioral problems. While a variety of treatments have been examined, the findings have yet to be consolidated, hampering advances in the treatment of TBI. A meta-analysis of research that has investigated the cognitive and behavioral effects of pharmacological treatments administered in the later stage after TBI was therefore conducted. The PubMed and PsycINFO databases were searched, and Cohen d effect sizes, percent overlap, and failsafe N statistics were calculated for each treatment. Both randomized controlled trials and open-label studies (prospective and retrospective) were included. Nineteen treatments were investigated by 30 independent studies, comprising 395 participants with TBI in the treatment groups and 137 control subjects. When treated in the postacute period, 1 dopaminergic agent (methylphenidate) improved behavior (anger/aggression, psychosocial function) and 1 cholinergic agent (donepezil) improved cognition (memory, attention). In addition, when the injury-to-treatment interval was broadened to include studies that administered treatment just before the postacute period, 2 dopaminergic agents (methylphenidate, amantadine) showed clinically useful treatment benefits for behavior, whereas 1 serotonergic agent (sertraline) markedly impaired cognition and psychomotor speed.Journal of clinical psychopharmacology 12/2011; 31(6):745-57. DOI:10.1097/JCP.0b013e318235f4ac · 3.76 Impact Factor