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Neuropsychopharmacology. 2017 Aug;42(9):1766-1775. doi: 10.1038/npp.2016.261. Epub 2016 Nov 22.

Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial.

Author information

1
Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.
2
Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
3
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
4
Department of Psychiatry, Geisel School of Medicine, Hanover, NH, USA.
5
Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.
6
Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA.
7
Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
8
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.
9
Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
10
Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA.
11
Center for Brain, Biology and Behavior, University of Nebraska, Lincoln, Lincoln, NE, USA.
12
Department of Speech-Language Pathology, Craig Hospital, Englewood, CO, USA.
13
Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.

Abstract

The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacological enhancement (ie, with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least 4 months before study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding four treatment combinations: MAAT/MPH (N=17), ABT/MPH (N=19), MAAT/placebo (N=17), and ABT/placebo (N=18). Assessments were conducted pre-treatment (baseline) and after 6 weeks of treatment (post treatment). Outcome measures included scores on neuropsychological measures and subjective rating scales. Statistical analyses used linear regression models to predict post-treatment scores for each outcome variable by treatment type, adjusting for relevant covariates. Statistically significant (P<0.05) treatment-related improvements in cognitive functioning were found for word-list learning (MAAT/placebo>ABT/placebo), nonverbal learning (MAAT/MPH>MAAT/placebo and MAAT/MPH>ABT/MPH), and auditory working memory and divided attention (MAAT/MPH>ABT/MPH). These results suggest that combined treatment with metacognitive rehabilitation (MAAT) and pharmacotherapy (MPH) can improve aspects of attention, episodic and working memory, and executive functioning after TBI.

PMID:
27874023
PMCID:
PMC5520776
DOI:
10.1038/npp.2016.261
[Indexed for MEDLINE]
Free PMC Article

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