RCT Methylphenidate & Memory/Attention Training in Traumatic Brain Injury
Principal Investigator: T W McAllister
Abstract: Traumatic brain injury (TBI) is a significant public health problem, with 1.5-2.0 million Americans injured each year. Cognitive deficits, particularly in the domains of memory and attention are frequently the source of lingering disability after TBI and a source of enormous distress to the injured individuals and their family/caregivers. To date, interventions to ameliorate chronic cognitive deficits have been directed at either pharmacological interventions or cognitive rehabilitation. We propose to (1) To compare the efficacy of three interventions: memory and attention training (MAAT), methylphenidate, and memory/attention training in combination with methylphenidate and (2) use functional MRI (fMRI) to characterize changes in activation of the neural circuitry of memory and attention due to MAAT alone, methylphenidate alone, and MAAT in combination with methylphenidate. This is a two by two design with medication (methylphenidate/placebo) and cognitive therapy (Memory and Attention Training (MAAT) or an Attention control intervention) as possible interventions. Using a randomized, placebo-controlled, double-blind design, 200 individuals with persistent cognitive deficits 6-12 months after MTBI will be randomized to receive a six week trial of either (1) MAAT and placebo, (2) MAAT and methylphenidate (0.3 mg/kg BID) (3) attention control intervention and methylphenidate (0.3 mg/kg BID) or (4) attention control intervention and placebo. Symptom distress attention and memory performance, and activation patterns of the neural circuitry of attention and memory while undergoing fMRI will be characterized at baseline, and after the four treatment conditions. This study will provide important information on three interventions for the most disabling sequelae of an enormous public health problem. Further, it will help to clarify underlying neural mechanisms and suggest additional treatment possibilities.
Funding Period: ----------------2006 - ---------------2011-
more information: NIH RePORT
- Genetic factors modulating outcome after neurotraumaThomas W McAllister
Section of Neuropsychiatry, Department of Psychiatry, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756, USA
PM R 2:S241-52. 2010..Polymorphisms reported to influence outcome after traumatic brain injury that illustrate important underlying mechanisms are emphasized...
- Treatment of post-traumatic cognitive impairmentsHal S Wortzel
VISN 19 Mental Illness Research, Education, and Clinical Center, Denver Veterans Affairs Medical Center, 1055 Clermont Street, Denver, CO, 80220, USA
Curr Treat Options Neurol 14:493-508. 2012..Titration to either beneficial effect or medication intolerance should be completed before discontinuing a treatment or augmenting partial responses with additional medications...
- Effects of psychological and biomechanical trauma on brain and behaviorThomas W McAllister
Department of Psychiatry, Section of Neuropsychiatry, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA
Ann N Y Acad Sci 1208:46-57. 2010..This paper reviews the literature on the neural substrate of biomechanical and psychological injury and discusses the implications for evaluation and treatment of the neuropsychiatric sequelae of these processes...
- Neurobiological consequences of traumatic brain injuryThomas W McAllister
Departments of Psychiatry and Neurology, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA
Dialogues Clin Neurosci 13:287-300. 2011..This paper reviews our current understanding of the neuropathophysiology of TBI and how this relates to the common clinical presentation of neurobehavioral difficulties seen after an injury...
- Addressing neuropsychiatric disturbances during rehabilitation after traumatic brain injury: current and future methodsDavid B Arciniegas
University of Colorado School of Medicine, Aurora, Colorado, USA
Dialogues Clin Neurosci 13:325-45. 2011..Finally, directions for future research that may address productively the challenges to TBI rehabilitation presented by neuropsychiatric disturbances are considered...