Escitalopram and Enhancement of Cognitive Recovery Following Stroke

Overview

Journal Arch Gen Psychiatry

Specialty Psychiatry

Date 2010 Feb 4

PMID 20124118

Citations 62

Authors

Ricardo E Jorge

Laura Acion

David Moser

Harold P Adams Jr

Robert G Robinson

Affiliations

Soon will be listed here.

Abstract

Context: Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability.

Objective: To examine the effect of escitalopram on cognitive outcome. We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy.

Design: Randomized trial.

Setting: Stroke center.

Participants: One hundred twenty-nine patients were treated within 3 months following stroke. The 12-month trial included 3 arms: a double-blind placebo-controlled comparison of escitalopram (n = 43) with placebo (n = 45), and a nonblinded arm of Problem Solving Therapy (n = 41).

Outcome Measures: Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail-Making, Controlled Oral Word Association, Wechsler Adult Intelligence Scale-III Similarities, and Stroop tests.

Results: We found a difference among the 3 treatment groups in change in RBANS total score (P < .01) and RBANS delayed memory score (P < .01). After adjusting for possible confounders, there was a significant effect of escitalopram treatment on the change in RBANS total score (P < .01, adjusted mean change in score: escitalopram group, 10.0; nonescitalopram group, 3.1) and the change in RBANS delayed memory score (P < .01, adjusted mean change in score: escitalopram group, 11.3; nonescitalopram group, 2.5). We did not observe treatment effects in other neuropsychological measures.

Conclusions: When compared with patients who received placebo or underwent Problem Solving Therapy, stroke patients who received escitalopram showed improvement in global cognitive functioning, specifically in verbal and visual memory functions. This beneficial effect of escitalopram was independent of its effect on depression. The utility of antidepressants in the process of poststroke recovery should be further investigated. Trial Registration clinicaltrials.gov Identifier: NCT00071643.

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References

Robbins T . Chemistry of the mind: neurochemical modulation of prefrontal cortical function. J Comp Neurol. 2005; 493(1):140-6. DOI: 10.1002/cne.20717. View

Martinsson L, Hardemark H, Eksborg S . Amphetamines for improving recovery after stroke. Cochrane Database Syst Rev. 2007; (1):CD002090. DOI: 10.1002/14651858.CD002090.pub2. View

Kimura M, Robinson R, Kosier J . Treatment of cognitive impairment after poststroke depression : a double-blind treatment trial. Stroke. 2000; 31(7):1482-6. DOI: 10.1161/01.str.31.7.1482. View

Duman R, Monteggia L . A neurotrophic model for stress-related mood disorders. Biol Psychiatry. 2006; 59(12):1116-27. DOI: 10.1016/j.biopsych.2006.02.013. View

Knopman D, Rocca W, Cha R, Edland S, Kokmen E . Survival study of vascular dementia in Rochester, Minnesota. Arch Neurol. 2003; 60(1):85-90. DOI: 10.1001/archneur.60.1.85. View

Chemerinski E, Robinson R, Kosier J . Improved recovery in activities of daily living associated with remission of poststroke depression. Stroke. 2001; 32(1):113-7. DOI: 10.1161/01.str.32.1.113. View

Cramer S . Repairing the human brain after stroke. II. Restorative therapies. Ann Neurol. 2008; 63(5):549-60. DOI: 10.1002/ana.21412. View

Klijn C, Hankey G . Management of acute ischaemic stroke: new guidelines from the American Stroke Association and European Stroke Initiative. Lancet Neurol. 2003; 2(11):698-701. DOI: 10.1016/s1474-4422(03)00558-1. View

Sonde L, Lokk J . Effects of amphetamine and/or L-dopa and physiotherapy after stroke - a blinded randomized study. Acta Neurol Scand. 2006; 115(1):55-9. DOI: 10.1111/j.1600-0404.2006.00728.x. View

10.

Duman R, Heninger G, Nestler E . A molecular and cellular theory of depression. Arch Gen Psychiatry. 1997; 54(7):597-606. DOI: 10.1001/archpsyc.1997.01830190015002. View

11.

Kavirajan H, Schneider L . Efficacy and adverse effects of cholinesterase inhibitors and memantine in vascular dementia: a meta-analysis of randomised controlled trials. Lancet Neurol. 2007; 6(9):782-92. DOI: 10.1016/S1474-4422(07)70195-3. View

12.

Gath D, Lloyd-Thomas A, Tomlinson D . Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. BMJ. 1995; 310(6977):441-5. PMC: 2548821. DOI: 10.1136/bmj.310.6977.441. View

13.

Harmer C, Bhagwagar Z, Cowen P, Goodwin G . Acute administration of citalopram facilitates memory consolidation in healthy volunteers. Psychopharmacology (Berl). 2002; 163(1):106-10. DOI: 10.1007/s00213-002-1151-x. View

14.

Encinas J, Vaahtokari A, Enikolopov G . Fluoxetine targets early progenitor cells in the adult brain. Proc Natl Acad Sci U S A. 2006; 103(21):8233-8. PMC: 1461404. DOI: 10.1073/pnas.0601992103. View

15.

Reding M, ORTO L, Winter S, Fortuna I, Di Ponte P, McDowell F . Antidepressant therapy after stroke. A double-blind trial. Arch Neurol. 1986; 43(8):763-5. DOI: 10.1001/archneur.1986.00520080011011. View

16.

Wolfson C, Wolfson D, Asgharian M, MLan C, Ostbye T, Rockwood K . A reevaluation of the duration of survival after the onset of dementia. N Engl J Med. 2001; 344(15):1111-6. DOI: 10.1056/NEJM200104123441501. View

17.

De Renzi E, Vignolo L . The token test: A sensitive test to detect receptive disturbances in aphasics. Brain. 1962; 85:665-78. DOI: 10.1093/brain/85.4.665. View

18.

Feeney D, De Smet A, Rai S . Noradrenergic modulation of hemiplegia: facilitation and maintenance of recovery. Restor Neurol Neurosci. 2004; 22(3-5):175-90. View

19.

Stroemer R, Kent T, Hulsebosch C . Enhanced neocortical neural sprouting, synaptogenesis, and behavioral recovery with D-amphetamine therapy after neocortical infarction in rats. Stroke. 1998; 29(11):2381-93; discussion 2393-5. DOI: 10.1161/01.str.29.11.2381. View

20.

Gladstone D, Danells C, Armesto A, McIlroy W, Staines W, Graham S . Physiotherapy coupled with dextroamphetamine for rehabilitation after hemiparetic stroke: a randomized, double-blind, placebo-controlled trial. Stroke. 2005; 37(1):179-85. DOI: 10.1161/01.STR.0000195169.42447.78. View