Methylphenidate is a
drug used to treat attention-deficit hyperactivity disorder. It is better
known by its trade name Ritalin.
A combination of the stimulant drug methylphenidate with a process
known as cognitive-behavioral rehabilitation is a promising option to
help people who suffer from persistent cognitive problems following
traumatic brain injury, researchers at Indiana University School of
Medicine have reported.
‘The combination of methylphenidate and cognitive-behavioral rehabilitation resulted in significantly better results in attention, episodic and working memory, and executive functioning after traumatic brain injury.’
The study, believed to be the first to systematically compare the
combination therapy to alternative treatments, was published online in
the journal Neuropsychopharmacology
, a Nature publication.
The researchers, led by Brenna McDonald, associate professor
of radiology and imaging sciences, and Thomas McAllister, chairman
of the Department of Psychiatry, compared the effectiveness of two forms
of cognitive therapy with and without the use of methylphenidate.
"We found that the combination of methylphenidate and Memory and
Attention Adaptation Training resulted in significantly better results
in attention, episodic and working memory, and executive functioning
after traumatic brain injury," said Dr. McDonald.
In the Memory and Attention Adaptation Training intervention - also
used to assist patients with cognitive issues following breast cancer
chemotherapy - therapists work with patients to help them develop
behaviors and strategies to improve performance in memory and other
In this study, this "metacognitive" approach was
compared with Attention Builders Training, which Dr. McDonald likened to
more of a "drill and practice" approach.
The 71 participants who completed the six-week trial were adults who
had experienced a traumatic brain injury of at least mild severity - a
blow to the head with some alteration of consciousness - at least four
months previously, and who either complained of having cognitive
problems, or who had been identified with cognitive problems in testing.
The participants were divided into four groups: the two cognitive
therapy approaches with the drug therapy, and the two approaches with
placebo. After six weeks, the researchers found that participants in the
combination metacognitive-Ritalin group improved significantly better
in word list learning, nonverbal learning and measures of
attention-related and executive function.
However, Dr. McDonald cautioned that due to the relatively small
number of participants in the each of the four arms of the trial - 17 to
19 people each - the results of the trial should be considered
Nonetheless, she said, the work breaks new ground in providing evidence for the combination therapy.
"There have been a few small studies suggesting methylphenidate
could help with attention and executive function after traumatic brain
injury, which makes senses because it's used to improve attention and
focus. But this is the first to test it in combination with
cognitive-behavioral therapy for treatment in traumatic brain injury,"
said Dr. McDonald.