title: Methylphenidate and Memory and Attention Adaptation Training for Persistent Cognitive Symptoms after Traumatic Brain Injury: A Randomized, Placebo-Controlled Trial.
abstract: The purpose of this multicenter, prospective, randomized, placebo-controlled study was to evaluate and compare the efficacy of two cognitive rehabilitation interventions (Memory and Attention Adaptation Training (MAAT) and Attention Builders Training (ABT)), with and without pharmacological enhancement (ie, with methylphenidate (MPH) or placebo), for treating persistent cognitive problems after traumatic brain injury (TBI). Adults with a history of TBI at least 4 months before study enrollment with either objective cognitive deficits or subjective cognitive complaints were randomized to receive MPH or placebo and MAAT or ABT, yielding four treatment combinations: MAAT/MPH (N=17), ABT/MPH (N=19), MAAT/placebo (N=17), and ABT/placebo (N=18). Assessments were conducted pre-treatment (baseline) and after 6 weeks of treatment (post treatment). Outcome measures included scores on neuropsychological measures and subjective rating scales. Statistical analyses used linear regression models to predict post-treatment scores for each outcome variable by treatment type, adjusting for relevant covariates. Statistically significant (P<0.05) treatment-related improvements in cognitive functioning were found for word-list learning (MAAT/placebo>ABT/placebo), nonverbal learning (MAAT/MPH>MAAT/placebo and MAAT/MPH>ABT/MPH), and auditory working memory and divided attention (MAAT/MPH>ABT/MPH). These results suggest that combined treatment with metacognitive rehabilitation (MAAT) and pharmacotherapy (MPH) can improve aspects of attention, episodic and working memory, and executive functioning after TBI.
authors.affiliation: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Brenna C
authors.initials: BC
authors.lastname: McDonald
authors.affiliation: Department of Psychiatry, Geisel School of Medicine, Hanover, NH, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Flashman
authors.affiliation: Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.|Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Arciniegas
authors.affiliation: Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ferguson
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Harezlak
authors.affiliation: Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Gwen C
authors.initials: GC
authors.lastname: Sprehn
authors.affiliation: Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.affiliation: Center for Brain, Biology and Behavior, University of Nebraska, Lincoln, Lincoln, NE, USA.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Maerlender
authors.affiliation: Department of Psychiatry, Geisel School of Medicine, Hanover, NH, USA.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Kruck
authors.affiliation: Department of Psychiatry, Geisel School of Medicine, Hanover, NH, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Gillock
authors.affiliation: Department of Speech-Language Pathology, Craig Hospital, Englewood, CO, USA.
authors.forename: Kim
authors.initials: K
authors.lastname: Frey
authors.affiliation: Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Rachel N
authors.initials: RN
authors.lastname: Wall
authors.affiliation: Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.|Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Andrew J
authors.identifier: http://orcid.org/0000-0002-1376-8532
authors.initials: AJ
authors.lastname: Saykin
authors.affiliation: Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: McAllister
mesh_terms: D000328:Adult; D001288:Attention / Q000187:drug effects; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D056344:Executive Function / Q000187:drug effects; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008568:Memory / Q000187:drug effects; D008774:Methylphenidate / Q000627:therapeutic use*; D009483:Neuropsychological Tests; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate