title: Effects of acetylcholinesterase inhibitors on cognitive function in patients with chronic traumatic brain injury: A systematic review.
abstract: OBJECTIVE
  To undertake a systematic review of the evidence for the effect of acetylcholinesterase inhibitors (AChEIs) on cognition late after moderate or severe traumatic brain injury.
  
  
  BACKGROUND
  Cognitive impairment after traumatic brain injury has significant consequences for the individual and society. Cholinergic pathways play an important role in cognitive processing and a hypocholinergic state exists in the chronic phases after traumatic brain injury. AChEIs are already used off-label to treat patients with traumatic brain injury.
  
  
  METHODS
  PubMed, CINAHL, PsycINFO, the Cochrane Collaboration and Web of Science were searched with pre-specified criteria between 1999 and June 2015.
  
  
  METHODS
  A total of 153 studies were identified. None met pre-specified criteria. The criteria were revised in order to identify studies that may provide useful information despite some risk of bias. Three studies met the revised criteria and were evaluated by 2 reviewers using the Swedish Council on Health Technology Assessment grading system, based on GRADE. Key findings and limitations were tabulated. One study found no effect and 2 found limited effect.
  
  
  CONCLUSIONS
  Large randomized controlled studies are needed to establish whether AChEIs are effective for cognition late after moderate or severe traumatic brain injury. Clinicians should be aware of the weak evidence base when considering the off-label use of AChEIs.
authors.affiliation: University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, SE-182 88 Stockholm, Sweden.
authors.forename: Marita
authors.initials: M
authors.lastname: Bengtsson
authors.forename: Alison K
authors.initials: AK
authors.lastname: Godbolt
mesh_terms: D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D056687:Off-Label Use; D063868:Patient Outcome Assessment
chemical_list: D002800:Cholinesterase Inhibitors