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[WEB PAGE] Adding ADHD drug to therapy improves cognitive outcomes in traumatic brain injury patients

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CREDIT: INDIANA UNIVERSITY SCHOOL OF MEDICINE

INDIANAPOLIS – A combination of the stimulant drug methylphenidate with a process known as cognitive-behavioral rehabilitation is a promising option to help people who suffer from persistent cognitive problems following traumatic brain injury, researchers at Indiana University School of Medicine have reported.

The study, believed to be the first to systematically compare the combination therapy to alternative treatments, was published online in the journal Neuropsychopharmacology, a Nature publication.

The researchers, led by Brenna McDonald, PsyD, associate professor of radiology and imaging sciences, and Thomas McAllister, MD, chairman of the Department of Psychiatry, compared the effectiveness of two forms of cognitive therapy with and without the use of methylphenidate, a drug used to treat attention-deficit/hyperactivity disorder and better known by its trade name, Ritalin.

“We found that the combination of methylphenidate and Memory and Attention Adaptation Training resulted in significantly better results in attention, episodic and working memory, and executive functioning after traumatic brain injury,” said Dr. McDonald.

In the Memory and Attention Adaptation Training intervention – also used to assist patients with cognitive issues following breast cancer chemotherapy – therapists work with patients to help them develop behaviors and strategies to improve performance in memory and other cognitive tasks. In this study, this “metacognitive” approach was compared with Attention Builders Training, which Dr. McDonald likened to more of a “drill and practice” approach.

The 71 participants who completed the six-week trial were adults who had experienced a traumatic brain injury of at least mild severity – a blow to the head with some alteration of consciousness – at least four months previously, and who either complained of having cognitive problems, or who had been identified with cognitive problems in testing.

The participants were divided into four groups: the two cognitive therapy approaches with the drug therapy, and the two approaches with placebo. After six weeks, the researchers found that participants in the combination metacognitive-Ritalin group improved significantly better in word list learning, nonverbal learning and measures of attention-related and executive function.

However, Dr. McDonald cautioned that due to the relatively small number of participants in the each of the four arms of the trial – 17 to 19 people each – the results of the trial should be considered preliminary.

Nonetheless, she said, the work breaks new ground in providing evidence for the combination therapy.

“There have been a few small studies suggesting methylphenidate could help with attention and executive function after traumatic brain injury, which makes senses because it’s used to improve attention and focus. But this is the first to test it in combination with cognitive-behavioral therapy for treatment in traumatic brain injury,” said Dr. McDonald.

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In addition to Drs. McDonald and McAllister, researchers contributing to the study were Gwen C. Sprehn, Flora M. Hammond, Jaroslaw Harezlak, Li Xing, Rachel N. Wall, and Andrew J. Saykin of the IU School of Medicine; Laura A. Flashman, Carrie L. Kruck, and Karen L. Gillock of the Geisel School of Medicine, Dartmouth College; David B. Arciniegas of the Baylor College of Medicine; Robert J. Ferguson of the Department of Medicine, University of Pittsburgh; Arthur C. Maerlender of the University of Nebraska and Kim Frey of Craig Hospital, Englewood, Colorado.

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (R01 HD047242). Dr. Arciniegas receives research support from the National Institute on Disability, Independent Living, and Rehabilitation Research (H133A120020, H133A130047) and Department of Veterans Affairs (CX000239) and receives compensation from American Psychiatric Association Publishing.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Source: Adding ADHD drug to therapy improves cognitive outcomes in traumatic brain injury patients | EurekAlert! Science News

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[WEB SITE] Traumatic Brain Injury: 6 Brain Functions That Suffer Most

Traumatic brain injury most often is the result of severe external force against the head. The force is violent enough to cause brain dysfunction and disrupt necessary brain and bodily functions.

When a traumatic brain injury occurs, according to the National Institutes of Health, several brain functions are disrupted causing various degrees of damage from mild to permanent.

Traumatic brain injury can be caused by blunt force trauma or by an object piercing the brain tissue.

Symptoms may be mild and temporary, moderate, or severe. Often, the injury requires brain surgery to remove ruptured blood vessels or bruised brain tissue.

Disabilities may arise depending on the extent of damage from the traumatic brain injury.

The following six brain functions suffer the most after a traumatic brain injury, according to the Mayo Clinic:

1. Nerves

When an injury occurs at the base of the skull and damages the cranial nerves, the following complications may result:

  • Facial muscle paralysis
  • Eye nerve damage resulting in double vision
  • Loss of sense of smell
  • Vision loss
  • Loss of facial sensation
  • Problems with swallowing

2. Intellect

A traumatic brain injury, depending on the severity of damage, can cause significant changes in cognitive and executive functioning abilities including the following:

  • Memory
  • Learning
  • Reasoning
  • Mental processing speed
  • Judgment
  • Attention or concentration
  • Problem-solving skills
  • Multitasking abilities
  • Organization
  • Decision-making
  • Task initiation or completion ability

3. Communication

Traumatic brain injuries can significantly disrupt and affect cognitive and communication skills and have lasting social implications. The following communication and social problems may result from a traumatic brain injury:

  • Difficulty understanding speech or writing
  • Difficulty with speech or writing
  • Disorganized thoughts
  • Conversational confusion and awkwardnes


4. Behavior

Behavioral changes may be seen after a traumatic brain injury and may include the following:

  • Lack of self-control
  • Risky behavior
  • Self-image issues
  • Social difficulties
  • Verbal or physical outbursts

5. Emotions

Emotional changes may include the following:

  • Depression
  • Anxiety
  • Mood swings
  • Irritability
  • Lack of empathy
  • Anger
  • Insomnia and other sleep-related problems
  • Self-esteem changes

6. Sensory

Damage from a traumatic brain injury may greatly affect a person’s senses including:

  • Ringing in the ears
  • Problems with hand-eye coordination
  • Blind spots or double vision
  • Issues with taste or smell
  • Tingling, pain, or itching of the skin
  • Dizziness or vertigo
  • Object-recognition difficulties

Source: Traumatic Brain Injury: 6 Brain Functions That Suffer Most

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