Effects of methylphenidate on cognition and apathy in normal pressure hydrocephalus: A case study and review

Abstract

The psychostimulant methylphenidate has been previously shown to improve cognitive performance in both normal control volunteers and patient populations. In the present case study, the effects of methylphenidate on cognitive and behavioural function were examined in a single patient with idiopathic normal pressure hydrocephalus (NPH) who had undergone ventriculoperitoneal shunting. A double-blind placebo-controlled ABBA drug design was employed, with the administration of two different doses of methylphenidate followed by neuropsychological assessment on a number of psychometric tests and cognitive tasks drawn from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Methylphenidate produced a dose-dependent positive improvement in behavioural measures in the patient associated with a reduction in apathy. It also had a dose-independent enhancing effect on performance of a Spatial Recognition task. These findings require replication in a large sample of patients to determine whether methylphenidate may prove to be generally useful in enhancing cognition and reducing apathy in normal pressure hydrocephalus.

Methylphenidate for the treatment of depressive symptoms, including fatigue and apathy, in medically ill older adults and terminally ill adults

“…All of the trials were small (between 1 and 70 participants) and compared methyphenidate with placebo. Seven trials, 20, 22, 24, 27, 29, 30, 32 including two “N-of-1” trials,27, 29 were crossover trials and six21, 23, 25, 26, 28, 31 were parallel comparisons. Most of the trials provide limited methodologic details, limiting our ability to assess the validity of the individual trials.…”

Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus

“…Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment 5,6,7 . Sometimes, even response to typical treatment in psychiatric syndromes may be impaired, like a described patient having schizophrenia with intolerance to even low dose of antipsychotics, who was subsequently revealed to be having communicating normal pressure hydrocephalus 19,20 . We did not evaluate a control group without NPH in order to compare our findings in idiopathic NPH patients.…”

The Role of Dopamine in Symptoms and Treatment of Apathy in Alzheimer's Disease

“…That study found a significant improvement in AES scores after 12 weeks of treatment. Other case reports have described using MTP to effectively treat apathy in the depressed population [135,136], the Parkinson's population [131], cerebrovascular accident patients [139], and patients with idiopathic normal pressure hydrocephalus [133]. Another recent RCT reported that apathy scores improved significantly in depressed patients who were treated with MTP in combination with an antidepressant, compared to patients using the antidepressant alone [138].…”