Article

OBJECTIVE: To undertake a systematic review of the evidence for the effect of
acetylcholinesterase inhibitors (AChEIs) on cognition late after moderate or
severe traumatic brain injury. BACKGROUND: Cognitive impairment after traumatic
brain injury has significant consequences for the individual and society.
Cholinergic pathways play an important role in cognitive processing and a
hypocholinergic state exists in the chronic phases after traumatic brain injury.
AChEIs are already used off-label to treat patients with traumatic brain injury.
DATA SOURCES AND STUDY SELECTION: PubMed, CINAHL, Psyc-INFO, the Cochrane
Collaboration and Web of Science were searched with pre-specified criteria
between 1999 and June 2015. DATA EXTRACTION AND SYNTHESIS: A total of 153 studies
were identified. None met pre-specified criteria. The criteria were revised in
order to identify studies that may provide useful information despite some risk
of bias. Three studies met the revised criteria and were evaluated by 2 reviewers
using the Swedish Council on Health Technology Assessment grading system, based
on GRADE. Key findings and limitations were tabulated. One study found no effect
and 2 found limited effect. CONCLUSION: Large randomized controlled studies are
needed to establish whether AChEIs are effective for cognition late after
moderate or severe traumatic brain injury. Clinicians should be aware of the weak
evidence base when considering the off-label use of AChEIs.

Langue : ANGLAIS