Pharmacotherapy to Enhance Cognitive and Motor Recovery Following Stroke

Abstract

Stroke is a leading cause of disability among older adults and more than half of stroke survivors have some residual neurological impairment. Traditionally, managing the aftermath of stroke has been by the implementation of several physical and language therapy modalities. The limitations of these rehabilitation efforts have sparked an interest in finding other ways to enhance neurological recovery. Some of these novel approaches have included pharmacological interventions, cell-derived treatments, and cortical magnetic stimulation. Mounting evidence over the last 2 decades suggests that pharmacological manipulations may have the potential to modulate practice-dependent neuroplasticity and potentially improve neurological recovery after stroke. Multiple pharmacological agents with different mechanisms of action have been evaluated, showing conflicting results. Some studies suggest some promise, yet the quality of the available studies is suboptimal overall, with most of the studies being underpowered. So far, the most promising agents include the antidepressants for motor recovery and acetylcholinesterase inhibitors and memantine for aphasia. However, large, well-designed clinical trials are needed to address the shortcomings of the available data and before any pharmacological agent can be recommended for routine use as part of the standard algorithm of stroke management.

Effects of rTMS Treatment on Cognitive Impairment and Resting-State Brain Activity in Stroke Patients: A Randomized Clinical Trial

“…The interventions of PSCI included controlling vascular risk factors, pharmacological treatments such as cholinesterase inhibitors (galantamine, donepezil, rivastigmine), the N -methyl D -aspartate antagonist memantine, and various Chinese medicines, cognitive training, and non-invasive stimulation ( Beristain and Golombievski, 2015 ; Iadecola et al, 2019 ). Recently, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and relatively safe electrophysiological technique, based on the principle of electromagnetic induction of an electric field in the brain, that has been widely used in the field of rehabilitation of post-stroke dysfunctions such as motor disorder, neglect, and swallowing impairment ( Winstein et al, 2016 ; Dionisio et al, 2018 ; Lefaucheur et al, 2020 ).…”

Neurophysiological predictors of aphasia recovery in patients with large left-hemispheric infarction

“…[22,23] Glutaminergic excitotoxicity is a significant contributor to cell death during acute stroke and is associated with over-activation of N-Methyl-D-Aspartate glutamate receptors. [24]…”

Effects of Combined Use of Intermittent Theta Burst Stimulation and Cognitive Training on Poststroke Cognitive Impairment

“…The currently available drugs are ineffective in preventing disease progression. 4 Cognitive training can encourage the ongoing progression of neuroplasticity and has been used extensively to treat PSCI. Combining cognitive training with additional techniques can reduce patient differences and enhance patient benefits.…”

“…Poststroke cognitive impairment affects patients’ quality of life and increases the burden of social and family support. The currently available drugs are ineffective in preventing disease progression 4 . Cognitive training can encourage the ongoing progression of neuroplasticity and has been used extensively to treat PSCI.…”