Donepezil, an acetylcholinesterase inhibitor, appears to be an effective treatment for severe, persistent verbal memory impairment after traumatic brain injury, according to a report in the Journal of Neuropsychiatry and Clinical Neurosciences.
Although the sample size was small, improvements in other cognitive domains such as processing speed were also observed in patients who responded to donepezil.
“Verbal memory impairments are common and persistent problems among persons with moderate to severe traumatic brain injury, interfere with everyday function, and are among the most important barriers to functional independence and productivity,” wrote lead author David Arciniegas, M.D., of the University of Colorado School of Medicine, and colleagues.
Arciniegas and colleagues randomized 75 patients with mild, moderate, or severe traumatic brain injury to receive donepezil 5 mg daily for two weeks followed by donepezil 10 mg daily for eight weeks or placebo for 10 weeks. After the 10-week treatment period, treatment was discontinued, and patients were observed for an additional four weeks. All patients were at least six months out from their injury.
Verbal learning as assessed by the Hopkins Verbal Learning Test–Revised was the primary outcome measure in this study. Secondary outcomes included co-occurring cognitive and noncognitive neuropsychiatric problems, and functional status.
Donepezil significantly improved verbal learning when compared with placebo. Overall, 42% of patients taking donepezil responded to treatment (defined as at least a 0.5-standard-deviation improvement in the Hopkins test total score), compared with 18% of those taking placebo. Among patients who responded to donepezil, improvements were also observed in other aspects of memory recognition and retention, attention, and executive function. The researchers observed no differences in improvement of everyday memory function (such as conversational memory) between the donepezil and placebo groups.
“Studies evaluating augmentation of evidence-based cognitive rehabilitation with donepezil, or other acetylcholinesterase inhibitors, are needed to better define the potential usefulness of such medications in the rehabilitation and long-term care of persons with persistent verbal memory impairments after [traumatic brain injury],” the authors concluded.
For more information, see the Psychiatric News article “Understanding the Breadth and Depth of the Subspecialty: TBI and Neuropsychiatry.”
(Image: Getty Images/iStock/AlexRaths)
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