Research Reports - Methylphenidate and memory and attention adaptation training for persistent cognitive symptoms after traumatic brain injury

Neuropsychopharmacology. 2017 Apr 5. doi: 10.1038/npp.2016.261. [Epub ahead of
print]

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

McDonald BC(1,)(2,)(3), Flashman LA(4), Arciniegas DB(5,)(6), Ferguson RJ(7),
Xing L(8,)(9), Harezlak J(8,)(9), Sprehn GC(2), Hammond FM(10), Maerlender
AC(11), Kruck CL(4), Gillock KL(4), Frey K(12), Wall RN(3), Saykin
AJ(1,)(2,)(3,)(13), McAllister TW(3).
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.

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