Cholinergic augmentation with donepezil enhances recovery in short-term memory and sustained attention after traumatic brain injury

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…These long-term deficits in cholinergic neuronal transmission may account for the memory and attention impairments, social interactive and cognitive deficits, and increased risk of Alzheimer's dementia with TBI (Deb, Lyons, & Koutzoukis, 1998). Consistent with these findings, cholinesterase inhibitors, as donepezil, that increase the available levels of acetylcholine in the brain, have been shown to improve attention and memory in moderate to severe TBI at 2 -24 months post-injury (Zhang, Plotkin, Wang, Sandel, & Lee, 2004). 3. Assessment of TBI 3.1.…”

“…Such a research design can be applied to the acute care setting, as the study that demonstrated that increasing rehabilitation intensity reduces length of hospital stay (Shiel et al, 2001) or in the chronic care setting, where structured, multidisciplinary rehabilitation in a community setting can improve social functioning (Powell et al, 2002). Using a RCT design, investigators have demonstrated that: direct patient involvement in neurorehabilitation goal setting resulted in a significant improvement in obtaining the goals from pre-test to post-test (Webb & Glueckauf, 1994), that donepezil improved attention and short-term memory (Zhang et al, 2004), and social communication skill training improved communication skills (Dahlberg et al, 2007). While findings from a well-designed RCT are statistically the most the convincing, they have limitations that include the financial and resource requirements of conducting such trials, the ethical implications of including a placebo or control group, and the masking of individual treatment responses due to data aggregation and group reporting.…”

“…The psychostimulant, dextroamphetamine, may also have the added benefit of reducing the variability in performance in tasks of attention and working memory (Hornstein, Lennihan, Seliger, Lichtman, & Schroeder, 1996), but the studies at this time are limited. Cholinesterase inhibitors, initially developed in treating dementia, as donepezil and physostigmine, have been useful in treating the memory deficits and improving attention following TBI (Cardenas et al, 1994;Griffin et al, 2003;Taverni, Seliger, & Lichtman, 1998;Zhang et al, 2004). Other drugs in this pharmacological class as, rivastigmine and galantamine, as well as, other drugs used in treating dementia, as the NMDA antagonist, memantine, need to be more systematically studied in future studies.…”

Pharmacological management of neurobehavioral disorders following traumatic brain injuryA state-of the-art review

“…One randomized crossover trial demonstrated attention and memory benefits with donepezil therapy, which were sustained after the washout period [79]. Another case series reported subjective improvement and improvement in processing speed, verbal memory, and divided attention in 8 of 10 subjects treated with donepezil [80].…”

Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury

“…One double-blind RCT showed improvements in attention and memory but not functional outcome among subjects randomized to donepezil [151]. A similar trial with rivastigmine did not show a difference over placebo, but a more severely injured subgroup did demonstrate some memory improvements with rivastigmine [152].…”