Pharmacotherapy for chronic cognitive impairment in traumatic brain injury

Dougall, Dominic; Poole, Norman; Agrawal, Niruj

doi:10.1002/14651858.cd009221.pub2

Cited by 28 publications

(31 citation statements)

References 44 publications

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“…The evidence based toolkit is a promising tool designed to help providers when prescribing neuropharmacological agents such as: antidepressants, cholinergics, psychostimulants, antipsychotics, and dopaminergic agents. As suggested by Poole 2015 [9], this may promote overall quality of care.…”

Section: Problem Descriptionmentioning

confidence: 96%

“…The evidence based pharmacology toolkit was implemented at this unit to help providers and team to reduce hospital costs [5]. That suggests the importance of an earlier intervention with brain stimulants when treating traumatic brain injury, specifically to treat poor alertness, that has been supported by a recent study [3,5,9,10,11].…”

Section: Problem Descriptionmentioning

confidence: 99%

“…A multidisciplinary team approach is used to improve the patient's quality of life as defined by the patient's and family's best interests. The team goals are focus on restoring and enhancing neurocognitive functions, which may involve the use of pharmacological approaches in addition to traditional neurohabilitation [9]. The main initial goal should be to improve level of consciousness in patients to help patients to advance through the disorder of consciousness program.…”

Section: Problem Descriptionmentioning

confidence: 99%

“…The literature review findings are consistent with the hypothesis that individuals with TBI have altered responsivity to dopamine. [5,9,25] This is why it is important to create and implement an evidence based pharmacological toolkit to help medical professionals provide positive outcomes for patients. This toolkit promises to be an effective tool to improve the pace of recovery during the acute rehabilitation stage for patients with post-acute or prolonged post-traumatic disturbances in consciousness.…”

Section: Available Knowledgementioning

confidence: 99%

“…Without proper diagnosis or pharmacological treatment, the patient may remain in persistent vegetative state, may fail to progress with the Disorder of Consciousness Program, and may eventually need to be transferred to a skilled nursing facility. In treating disorders of consciousness, medical professionals must seek to improve the level of consciousness and safeguard the brain [4,5,6,8,9].…”

Section: Available Knowledgementioning

confidence: 99%

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Development and Implementation of a Pharmacological Toolkit to Help Providers Manage Level of Consciousness Following Traumatic Brain Injury: A Quality Improvement Project

Santana¹

2017

AJMS

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Introduction: Traumatic brain injury (TBI) is a serious public health concern in the USA. Each year, TBIs contribute to a total of 52,000 deaths, accounting for 30% of all injury-related deaths and cases of permanent disability. Approximately 5 million survivors of TBI in the USA live with some form of disability [1]. Due to the severity of the brain injuries, some patients will experience a reduced level of consciousness. Early use of pharmacological treatment is fundamental to improve patient outcomes. Background: Providers presently seek guidelines to help them choose the right medication quickly and accurately. A pharmacological toolkit was designed to help providers in the neurology unit to enhance patients' level of consciousness and improve quality of care following a traumatic brain injury. The theoretical model for this project is the Havelock Theory of Change, which was used to guide the team during the stages of change. The Logic Model was used during the development and implementation of the toolkit. Methods: This project was developed and implemented in the medical neurological unit at the long term acute care and rehabilitation hospital. An educational program was initiated for providers to help them use the evidence based pharmacological toolkit to prescribe neuro-stimulates for patients with TBIs who demonstrated poor levels of consciousness. The Coma Recovery Scale -Revised (CRS-R) scale [2] was used to reassure if effectiveness of the neuropharmacology was feasible to treat poor alertness. The percentage of improvement on CRS-R score of 27.68%, with improvement of 3 points on CRS-R score, is a significant improvement to this QI project. The data was collected over six months and captured the variability reflecting improvement. A post implementation survey was answered by providers to track the benefit and practicability of the tool. Results: The level of satisfaction was high based on the survey response. Conclusion: Use of a neuropharmacological toolkit promises to help providers to treat severe traumatic brain injury in patients experiencing poor level of alertness. In conclusion, following the national brain injury organization recommendations, every institution needs to develop their own guideline to treat TBIs.

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Section: Problem Descriptionmentioning

confidence: 96%

Section: Problem Descriptionmentioning

confidence: 99%

Section: Problem Descriptionmentioning

confidence: 99%

Section: Available Knowledgementioning

confidence: 99%

Section: Available Knowledgementioning

confidence: 99%

See 3 more Smart Citations

Development and Implementation of a Pharmacological Toolkit to Help Providers Manage Level of Consciousness Following Traumatic Brain Injury: A Quality Improvement Project

Santana¹

2017

AJMS

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Pharmacotherapy to Improve Cognitive Functioning After Acquired Brain Injury: A Meta‐Analysis and Meta‐Regression

van der Veen,

Königs,

Bakker

et al. 2024

Clin Pharma and Therapeutics

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Cognitive impairments, common sequelae of acquired brain injury (ABI), significantly affect rehabilitation and quality of life. Currently, there is no solid evidence‐base for pharmacotherapy to improve cognitive functioning after ABI, nevertheless off‐label use is widely applied in clinical practice. This meta‐analysis and meta‐regression aims to quantitatively aggregate the available evidence for the effects of pharmacological agents used in the treatment of cognitive impairments following ABI. We conducted a comprehensive search of Embase, Medline Ovid, and Cochrane Controlled Trials Register databases for randomized controlled and crossover trials. Meta‐analytic effects were calculated for each pharmaceutical agent and targeted neuromodulator system. Cognitive outcome measures were aggregated across cognitive domains. Of 8,216 articles, 41 studies (4,434 patients) were included. The noradrenergic agent methylphenidate showed a small, significant positive effect on cognitive functioning in patients with traumatic brain injury (TBI; k = 14, d = 0.34, 95% confidence interval: 0.12–0.56, P = 0.003). Specifically, methylphenidate was found to improve cognitive functions related to executive memory, baseline speed, inhibitory control, and variability in responding. The cholinergic drug donepezil demonstrated a large effect size, albeit based on a limited number of studies (k = 3, d = 1.68, P = 0.03). No significant effects were observed for other agents. Additionally, meta‐regression analysis did not identify significant sources of heterogeneity in treatment response. Our meta‐analysis supports the use of methylphenidate for enhancing cognitive functioning in patients with TBI. Although donepezil shows potential, it warrants further research. These results could guide clinical decision making, inform practice guidelines, and direct future pharmacotherapeutic research in ABI.

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Clinical Management of the Homeless Patient with Traumatic Brain Injury and Cognitive Impairment

Subbarao

Eapen

2021

Clinical Management of the Homeless Patient

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Pharmacotherapy for chronic cognitive impairment in traumatic brain injury

Cited by 28 publications

References 44 publications

Development and Implementation of a Pharmacological Toolkit to Help Providers Manage Level of Consciousness Following Traumatic Brain Injury: A Quality Improvement Project

Development and Implementation of a Pharmacological Toolkit to Help Providers Manage Level of Consciousness Following Traumatic Brain Injury: A Quality Improvement Project

Pharmacotherapy to Improve Cognitive Functioning After Acquired Brain Injury: A Meta‐Analysis and Meta‐Regression

Clinical Management of the Homeless Patient with Traumatic Brain Injury and Cognitive Impairment

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