Affiliations: Brain Injury Rehabilitation Unit, HealthONE Spalding
Rehabilitation Hospital, Aurora, CO, USA | Neuropsychiatry Service, Department of Psychiatry,
University of Colorado School of Medicine, Denver, CO, USA | Behavioral Neurology Section, Department of Neurology,
University of Colorado School of Medicine, Denver, CO, USA | New York University School of Medicine, New York, NY,
USA
Note: [] Corresponding author: David B. Arciniegas, M.D., Campus Box
C268-25, 4200 East Ninth Avenue, Denver, CO 80262, USA. Tel.: +1 303 315 5365;
Fax: +1 303 315 5641; E-mail: [email protected]
Abstract: Pharmacotherapy may contribute to the rehabilitation of persons with
posttraumatic cognitive impairments. This article reviews first the
neurobiological consequences of traumatic brain injury with a particular
emphasis on acute and long-term posttraumatic neurochemical disturbances.
Studies of pharmacotherapies for posttraumatic cognitive impairments are
reviewed next, and are organized according to medication class and the
neurotransmitter system they affect most. Based on the evidence provided by
that review, augmentation of posttraumatic cerebral catecholaminergic and
cholinergic function are suggested as potentially useful neurochemical targets
for pharmacologic intervention in this population. More specifically, it is
suggested that persons with posttraumatic impairments in arousal, speed of
processing, and possibly attention may benefit most from treatment with an
agent that augments cerebral catecholaminergic function, and that persons whose
predominant posttraumatic impairment is in the domain of memory may benefit
most from treatment with cholinesterase inhibitors. Practical considerations
regarding the use of pharmacotherapies for posttraumatic cognitive impairments
are offered, and the need for additional research in this area is
highlighted.
