title: Effect of methylphenidate and/or levodopa combined with physiotherapy on mood and cognition after stroke: a randomized, double-blind, placebo-controlled trial.
abstract: OBJECTIVE
  Stimulant medications can enhance mood and cognition in stroke rehabilitation, but human clinical trial results are inconclusive. We sought to prospectively study the effects of levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy on mood and cognition following stroke in human subjects.
  
  
  METHODS
  Ischemic stroke patients were enrolled in our study 15 to 180 days after stroke onset. The patients were randomized into four medication groups (MPH, LD, MPH + LD, or placebo) and received a 15-day course of medication therapy (1 dose daily) and 45-min standard physiotherapy treatment daily. Mood and cognitive function were assessed at the study onset and 15, 90 and 180 days after study enrollment.
  
  
  RESULTS
  The strongest improvement of mood and cognition was found between baseline and the first follow-up immediately after the intervention. A significant improvement in mood was also found in the combined treatment group (MPH + LD) at 90 and 180 days, compared to the placebo group.
  
  
  CONCLUSIONS
  A 15-day course of daily MPH + LD combined with physiotherapy over a 3-week period was safe and significantly improved mood status in ischemic stroke patients. Future studies are needed which determine the optimal therapeutic window for and dosage of psychostimulants as well as identify those stroke patients who might benefit the most from treatment.
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden. ahmad.delbari@ki.se
authors.forename: Ahmad
authors.initials: A
authors.lastname: Delbari
authors.forename: Reza
authors.initials: R
authors.lastname: Salman-Roghani
authors.forename: Johan
authors.initials: J
authors.lastname: Lokk
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology / Q000628:therapy*; D009483:Neuropsychological Tests; D026741:Physical Therapy Modalities; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000978:Antiparkinson Agents; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D007980:Levodopa