Arciniegas David B, Silver Jonathan M
Brain Injury Rehabilitation Unit, HealthONE Spalding Rehabilitation Hospital, Aurora, CO, USA.
Behav Neurol. 2006;17(1):25-42. doi: 10.1155/2006/460592.
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.
药物治疗可能有助于创伤后认知障碍患者的康复。本文首先回顾创伤性脑损伤的神经生物学后果，特别强调急性和长期创伤后神经化学紊乱。接下来回顾创伤后认知障碍药物治疗的研究，并根据药物类别及其最影响的神经递质系统进行组织。基于该综述提供的证据，创伤后脑儿茶酚胺能和胆碱能功能的增强被认为是该人群药物干预潜在有用的神经化学靶点。更具体地说，建议觉醒、处理速度以及可能还有注意力存在创伤后损伤的患者，使用增强脑儿茶酚胺能功能的药物治疗可能获益最大，而创伤后主要损伤在记忆领域的患者，使用胆碱酯酶抑制剂治疗可能获益最大。文中还提供了关于创伤后认知障碍药物治疗使用的实际考虑因素，并强调了该领域进一步研究的必要性。
