COGNITIVE SEQUALE sequale of TBI OF TBI

Transcription

1 Treating TREATING the cognitive THE COGNITIVE SEQUALE sequale of TBI OF TBI Birgitta Johansson, PhD Sahlgrenska Academy, University of BIRGITTA JOHANSSON SAHLGRENSKA ACADEMY, UNIVERSITY Gothenburg OF GOTHENBURG

2 Treatment studies Central stimulating drugs Methylphenidate OSU6162 Mindfulness

3 Mental fatigue Many report long-term mental fatigue after a TBI. A lack of mental energy. Inability to sustain cognitive performance over time, again and again, interfering with daily activities. Also a disproportionally long recovery time needed to restore mental energy.

4 Methylphenidate feasibility study Phase A, 3 months No medication/low dose/normal dose, 3 groups treatade in random order Phase B, 6 months Baseline E1 E2 E3 E4 54 mild TBI included 44 fulfilled phase A 30 followed up at 6 months

5 Assessments Mental Fatigue Scale, MFS Depression and anxiety, Comprehensive Psychopathological Rating Scale (CPRS) Quality of life, SF36 Cognitive tests: information processing speed (Digit symbol coding), attention (Trail Making Test) and working memory (Digit span)

6 MFS MFS mental fatigue scale SAHLGRENSKA AKADEMIN

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8 Cods/2 min SAHLGRENSKA AKADEMIN Processing speed coding WAIS-III No treatment Low dose Normal dose

9 Methylphenidate baseline to 6 months + improvement (<0.001) Attention Working memory Depression Anxiety

10 Now clinical follow-up after 6 years Johansson, B., Wentzel, A-P., Andréll, P., Rönnbäck, L. and Mannheimer, C. (2017) Long-term treatment with methylphenidate for fatigue after traumatic brain injury. Acta Neurologica Scandinavica, 135, Johansson, B., Wentzel, A-P., Andréll, P., Rönnbäck, L and Mannheimer, C. (2015) Methylphenidate reduces mental fatigue and improves processing speed in persons suffered a traumatic brain injury. Brain Injury, 29(6): Johansson, B., Wentzel, A-P., Andréll, P., Odenstedt, J., Mannheimer, C., Rönnbäck, L. (2014). Evaluation of dosage, safety and effects of methylphenidate on posttraumatic brain injury symptoms with focus on mental fatigue and pain. Brain Injury 28(3):

11 OSU6162 dopamin- och serotoninstabilizer 4 weeks+ 4 weeks, Cross-over studie OSU6162 OSU6162 Placebo Placebo

12 MFS SAHLGRENSKA AKADEMIN 25 OSU6162 TBI and stroke Placebo OSU6162 Johansson, B., Carlsson, A., Carlsson, M. L., Karlsson, M., Nilsson, M. K. L., Nordquist-Brandt, E., & Rönnbäck, L. (2012). Placebo-controlled cross-over study of the monoaminergic stabiliser ( )-OSU6162 in mental fatigue following stroke or traumatic brain injury. Acta Neuropsychiatrica,, 24(5),

13 MINDFULNESS SAHLGRENSKA AKADEMIN

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15 Research has proven mindfulness to be effective for a wide range of conditions as stress, depression, pain, and fatigue and improved attention, and psychological well-being, with the potential of helping individuals to cope better with their difficulties.

16 MBSR MindfulnessBased StressReduction 8 weekly sessions The MBSR program was created 38 years ago by John Kabat Zinn, The Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School

17 Studie design, TBI och stroke MBSR 1: 5 TBI, 7 stroke Control: 5 TBI, 9 stroke MBSR 2: 5 TBI, 5 stroke Johansson, B., Bjuhr, H., & Rönnbäck, L. (2012). Mindfullness based stress reduction impairs long-term mental fatigue after stroke or traumatic brain injury. Brain Injury, 26(13-14):

18 MFS SAHLGRENSKA AKADEMIN 25 MBSR, mental fatigue scale 20 ** ** ** MBSR gr 1 pretest MBSR gr 1 posttest Control pretest Control posttest MBRS gr 2 pretest MBSR gr 2 posttest Johansson, B., Bjuhr, H., & Rönnbäck, L. (2012). Mindfullness based stress reduction impairs long-term mental fatigue after stroke or traumatic brain injury. Brain Injury, 26(13-14):

19 MBSR live on internet MBSR live on Internet, 6 TBI, 7 stroke MBSR face-to-face, 7 TBI, 5 stroke Control, 3 TBI, 6 stroke -walking in the Botanical garden Johansson, B, Bjuhr, H, Karlsson, M, Karlsson, J-O, Rönnbäck, L. Mindfulness-Based Stress Reduction (MBSR) Delivered Live on the Internet to Individuals Suffering from Mental Fatigue After an Acquired Brain Injury. Mindfulness. 2015;6:

20 MFS MBSR - Reduced mental fatigue Results from one-way repeated measure ANOVA, Interaction p=0.004 SAHLGRENSKA AKADEMIN Start After 0 MBSR faceto-face group MBSR internet 1 Control

21 AB T2 Changes from pretest to posttest MBSR live on Internet Attentional SAHLGRENSKA AKADEMIN Blink test. Post-test minus pre-test MBSR face-to-face * MBSR Internet Control walking * * ms 504 ms 756 ms Distance between T1 and T2

22 Summary Methylphenidate reduced mental fatigue, and improved cognition, but still need to balance the mental activity carefully. Improvement in well-being but not in working capacity. Mindfulness reduced mental fatigue, improved attention. Brain rest, insight, acceptance, new ways to handle life, compassion.

23 Mental Fatigue - summary Etiology is poorly understood. Development of efficient treatments for fatigue is important today we can alleviate fatigue. ENERGY CRISIS?

24 Thanks!