Wednesday, February 3, 2010

Escitalopram and Enhancement of Cognitive Recovery Following Stroke

The new issue of *Archives of General Psychiatry* (Vol. 67 No. 2)includes a study: "Escitalopram and Enhancement of Cognitive RecoveryFollowing Stroke."The authors are Ricardo E. Jorge, MD; Laura Acion, MS; David Moser, PhD;Harold P. Adams Jr, MD; & Robert G. Robinson, MD.

ContextAdjunctive restorative therapies administered during the first fewmonths after stroke, the period with the greatest degree of spontaneousrecovery, reduce the number of stroke patients with significant disability.

Objective: To examine the effect of escitalopram on cognitive outcome. Wehypothesized that patients who received escitalopram would show improvedperformance in neuropsychological tests assessing memory and executivefunctions than patients who received placebo or underwent ProblemSolving Therapy.DesignRandomized trial.SettingStroke center.

Participants: One hundred twenty-nine patients were treated within 3 months followingstroke. 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 MeasuresChange in scores from baseline to the end of treatment for theRepeatable Battery for the Assessment of Neuropsychological Status(RBANS) and Trail-Making, Controlled Oral Word Association, WechslerAdult Intelligence Scale-III Similarities, and Stroop tests.

Result: sWe found a difference among the 3 treatment groups in change in RBANStotal score (P < .01) and RBANS delayed memory score (P < .01). Afteradjusting for possible confounders, there was a significant effect ofescitalopram treatment on the change in RBANS total score (P < .01,adjusted mean change in score: escitalopram group, 10.0; nonescitalopramgroup, 3.1) and the change in RBANS delayed memory score (P < .01,adjusted mean change in score: escitalopram group, 11.3; nonescitalopramgroup, 2.5). We did not observe treatment effects in otherneuropsychological measures.

Conclusions: When compared with patients who received placebo or underwent ProblemSolving Therapy, stroke patients who received escitalopram showedimprovement in global cognitive functioning, specifically in verbal andvisual memory functions. This beneficial effect of escitalopram wasindependent of its effect on depression. The utility of antidepressantsin the process of poststroke recovery should be further investigated.

1 comment:

MIke said...

the brain is very plastic and has a great ability to teach another part of the brain to take over from the effected area of the brain. There are lots treatments to help archive this, including Mirror Box Therapy that has lots of evidence that it works. There is a great website www.mirrorboxtherapy.com with great info and a link to where you can buy a folding mirror box.