Effects of Oral Physostigmine and Lecithin on Memory and Attention in Closed Head-Injured Patients

Abstract

In view of the evidence for the role of the central cholinergic pathways in memory and preliminary studies suggesting alteration of neurotransmitters after severe head injury, we completed a double-blind, placebo-controlled study of combined oral physostigmine and lecithin. Sixteen survivors of moderate to severe closed head injury who had unequivocal memory deficit were studied during the course of inpatient rehabilitation. Although the results generally indicated no difference in the effects of the physostigmine-lecithin combination as compared to lecithin alone, sustained attention on the continuous performance test was more efficient under physostigmine than placebo when the drug condition occurred first in the crossover design. Further investigation of neurotransmitter manipulation is warranted in patients with traumatic brain injury.

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

“…Another study combining physostigmine with lecithin did not show an improvement with measures of memory [77].…”

“…Although some have reported positive results in cognitive impairment following brain injury, physostigmine's utility is limited by its short duration of action and adverse effect profile. One study comparing physostigmine/lecithin to lecithin alone in 16 subjects with moderate to severe TBI with memory deficits found no difference in measures of attention and memory between the two treatment groups, apart from improved sustained attention on the continuous performance test when physostigmine was initiated first in the crossover design [77]. A double-blind, placebocontrolled study comparing the effect of physostigmine, placebo, and scopolamine on attention and memory in 36 subjects found improvement in scores on one measure of attentional processes in the physostigmine group [78].…”

Effect of Growth Hormone Replacement Therapy on Cognition after Traumatic Brain Injury

“…Most strategies for intervention have focused on acute interventions with neuroprotective agents (Clifton, , 2004Empey et al, 2006;Narayan et al, 2002). Pharmacological (Levin et al, 1986;Plenger et al, 1996;Poole and Agrawal, 2008), and cognitive interventions for persons with chronic TBI have met with marginal success (Cicerone et al, 2000(Cicerone et al, , 2005High et al, 1995High et al, , 2005Sohlberg and Mateer, 1987).…”

Traumatic brain injury in older adults

“…Literature review shows that there are no double blind, placebo-controlled trials of the effects of cholinesterase inhibitors (Ach-I) on memory after TBI in individuals more than 65 years of age. In individuals of any age, there are only two double blind, placebo-controlled design studies of Ach-I, both of them using physostigmine [35,36]. Physostigmine was the most frequently studied Ach-I drug in the early phases of the development of antidementia drugs [37].…”