Article of the month of April by Dr. David Burke

After a traumatic brain injury (TBI), individuals struggle with cognitive impairments, particularly impairment of executive function. As executive function can be manipulated by agents with an affinity for the dopaminergic or noradrenergic system, this study of patients with a mild TBI assessed the effect of methylphenidate on executive function.
Subjects were adults up to 35 years of age seen between October of 2015 and December of 2016 for evaluation and treatment of a TBI. All were tested with the Arabic version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQODE). Those with scores at level II (minor deterioration) were eligible for inclusion in the study. Executive function was tested using the Trail Making Test (TMT), the Wisconsin Sorting Test (WST) and the Tower of London (TOL) test. In addition, all were tested for verbal fluency, and screened for anxiety and depression symptoms with the Hospital Anxiety and Depression Scale (HADS). The subjects were tested at baseline, at maximum dose of methylphenidate (10mg per day) and after methylphenidate withdrawal.

On measures of executive function, Digit Span scores increased with methylphenidate and decreased with withdrawal (p<0.001 for both comparisons). Treatment with methylphenidate also improved verbal fluency, which deteriorated after methylphenidate withdrawal (p<0.001 and p=0.008, respectively). Depression improved with methylphenidate (p=0.033), but did not deteriorate after withdrawal (p=0.150). Methylphenidate had no effect on anxiety.

Conclusion: This study further demonstrates the utility of methylphenidate for the treatment of those with mild TBI. Of note, this study, as many before, failed to find that this medication exacerbates anxiety; still a commonly held misconception.

Al-Adawi, S., et al. Methylphenidate Improves Executive Functions in Patients with Traumatic Brain Injuries: A Feasibility Trial via the Idiographic Approach. BMC Neurol. 2020, March 19; 20(1): 103.