DONEPEZIL MEDIATED MEMORY IMPROVEMENT IN TRAUMATIC BRAIN INJURY DURING POST ACUTE REHABILITATION

Memory dysfunction is a recognized and difficult to treat complication of traumatic brain injury (TBI). Since medial-temporal lobe injury is a frequent contributor to memory dysfunction in TBI, it is likely tha t an acetylcholine deficit contributes to memory dysfunction in this p opulation. Recently, Donepezil, an acetylcholine-esterase inhibitor wh ich has demonstrated a high selectivity for neural Ach-esterase (with minimal side effects), was approved for use in dementia in Alzheimer's patients. Due to its promising results in Alzheimer's patients, and r eports in the literature describing the use of physostigmine (an anti- cholinesterase with significant cardiovascular and autonomic side effe cts) to treat memory deficits in closed head injury, we decided to beg in a trial of Donepezil in two patients with TBI who were experiencing long term static memory dysfunction refractory to conventional treatm ent. Both patients were admitted to our facility for physical and cogn itive rehabilitation, and were started on a trial of Donepezil. Modifi ed memory tests and subjective observations by both family and staff p ointed to an improvement in memory within three weeks of starting Done pezil. Should these initial results be supported in larger trials, Don epezil may prove to be a valuable tool for the treatment of memory dys function in TBI.