What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD)

Advokat, Claire

doi:10.1016/j.neubiorev.2010.03.006

Cited by 190 publications

(183 citation statements)

References 97 publications

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“…In support of the subjective improvement in cognitive function, MPH was also associated with significant improvement in objective tests of attention and speed of information processing, domains known to be responsive to stimulants, including MPH, in other populations with cognitive complaints and deficits such as attention deficit disorder (MTA Working Group, 1999;Advokat, 2010). GAL was associated with improved episodic memory, also consistent with previous work in other populations such as Alzheimer's disease where this agent is FDA approved for treatment of the episodic memory problems that are the hallmark of that disorder.…”

Section: Discussion Overviewmentioning

confidence: 92%

Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury

McAllister

Zafonte

Jain

et al. 2015

Neuropsychopharmacol

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We report findings from a 12-week randomized double-blinded placebo-controlled trial of methylphenidate or galantamine to treat emotional and cognitive complaints in individuals (n = 32) with a history of PTSD, TBI, or both conditions. In this small pilot study, methylphenidate treatment was associated with clinically meaningful and statistically significant improvement compared with placebo on the primary outcome, a measure of cognitive complaints (Ruff Neurobehavioral Inventory-Postmorbid Cognitive Scale), as well as on the secondary outcomes reflecting post-concussive (Rivermead Post Concussive Symptom Questionnaire) and post-traumatic stress symptoms (Posttraumatic Stress Disorder Checklist). Treatment was well tolerated. These results suggest the need for a larger RCT to replicate and confirm these findings. Design considerations for such a trial should include the need for multiple sites to facilitate adequate recruitment and extension of the treatment and follow-up periods.

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Section: Discussion Overviewmentioning

confidence: 92%

Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury

McAllister

Zafonte

Jain

et al. 2015

Neuropsychopharmacol

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“…For example, Chamberlain, Robbins, Winder-Rhodes, Muller, Sahakian, Blackwell and Barnett (2010) reviewed studies in which CANTAB tasks had been used to assess stimulant effects in patients and healthy control participants. They concluded that -acute doses of medication improved aspects of cognition, though findings were more consistent in subjects with ADHD than in healthy volunteers.‖ Reviewing the literature on the cognitive effects of methylphenidate, Repantis, Schlattmann, Laisney & Heuser (2010) state that they were -not able to provide sufficient evidence of positive effects in healthy individuals from objective tests.‖ Similarly, Hall and Lucke (2010) state that -There is very weak evidence that putatively neuroenhancing pharmaceuticals in fact enhance cognitive function.‖ An even stronger view was presented by Advokat (2010), whose reading of the literature led her to suggest that -studies in non-ADHD adults suggest that stimulants may actually impair performance on tasks that require adaptation, flexibility and planning.‖ Most recently, Smith and Farah (2011) surveyed more than fifty experiments on the effects of amphetamine and methylphenidate on a wide array of cognitive functions, including memory (episodic memory, procedural memory and probabilistic learning) and executive functions (working memory, cognitive control) in healthy young adults. They discovered a roughly even mixture of significant enhancement effects and null findings overall.…”

Section: 1stimulants' Actual Cognitive Enhancement Effectsmentioning

confidence: 99%

Objective and subjective cognitive enhancing effects of mixed amphetamine salts in healthy people

2013

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Psychostimulants such as mixed amphetamine salts (MAS, brand name Adderall) are widely used for cognitive enhancement by healthy young people, yet laboratory research on effectiveness has yielded variable results. The present study assessed the effects of MAS in healthy young adults with an adequately powered double-blind cross-over placebo-controlled trial. We examined effects in 13 measures of cognitive ability including episodic memory, working memory, inhibitory control, convergent creativity, intelligence and scholastic achievement, with the goals of determining (1) whether the drug is at least moderately enhancing (Cohen's d >= .5) to some or all cognitive abilities tested, (2) whether its effects on cognition are moderated by baseline ability or COMT genotype, and (3) whether it induces an illusory perception of cognitive enhancement. The results did not reveal enhancement of any cognitive abilities by MAS for participants in general. There was a suggestion of moderation of enhancement by baseline ability and COMT genotype in a minority of tasks, with MAS enhancing lower ability participants on word recall, embedded figures and Raven's Progressive Matrices. Despite the lack of enhancement observed for most measures and most participants, participants nevertheless believed their performance was more enhanced by the active capsule than by placebo. We conclude that MAS has no more than small effects on cognition in healthy young adults, although users may perceive the drug as enhancing their cognition. AbstractPsychostimulants such as mixed amphetamine salts (MAS, brand name Adderall) are widely used for cognitive enhancement by healthy young people, yet laboratory research on effectiveness has yielded variable results. The present study assessed the effects of MAS in healthy young adults with an adequately powered double-blind cross-over placebo-controlled trial. We examined effects in 13 measures of cognitive ability including episodic memory, working memory, inhibitory control, convergent creativity, intelligence and scholastic achievement, with the goals of determining (1) whether the drug is at least moderately enhancing (Cohen's d >= .5) to some or all cognitive abilities tested, (2) whether its effects on cognition are moderated by baseline ability or COMT genotype, and (3) whether it induces an illusory perception of cognitive enhancement. The results did not reveal enhancement of any cognitive abilities by MAS for participants in generalThere was a suggestion of moderation of enhancement by baseline abilityand COMT genotype in a minority of tasks, with MAS enhancing lower ability participants on word recall, embedded figures and Raven's Progressive Matrices. Despite the lack of enhancement observed for most measures and most participants, participants nevertheless believed their performance was more enhanced by the active capsule than by placebo. We conclude that MAS has no more than small effects on cognition in healthy young adults, although users may perceive the drug as enhancing their ...

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“…However, some persons do not respond to medications at all or have adverse responses and hence are lacking medical treatment (20-50%; Wilens et al 2002). Furthermore, most individuals treated with medications continue to evidence at least some residual symptoms and functional impairments (Advokat 2010;Antshel 2015;Rapport et al 2013). Therefore, recommendations for treatment of ADHD call for further intervention concomitant with medications (Safren 2006), in order to provide patients with skills for coping with attentional impairments.…”

Section: Introductionmentioning

confidence: 99%

Computerized Progressive Attention Training (CPAT) vs. Active Control in Adults with ADHD

et al. 2017

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Higher education students with ADHD cope with various academic obstacles such as difficulty to sustain attention while studying and deficient ability to focus attention effectively on academic tasks. Shalev et al. (Child Neuropsychology, 13(4), 382-388, 2007) have developed a computerized progressive attentional training (CPAT) program for children with ADHD, which is composed of four sets of structured tasks designed to uniquely activate various attentional functions: sustained-, selective-spatial, orienting-, and executive-attention. The goal of the present study was to evaluate the effect of the CPAT vs. an active control training program on improving attention functioning among high functioning adults with ADHD. Thirty participants, randomly assigned either to the CPAT or to the active control (computer games; CG) groups, completed 16 1-h training sessions across 8 weeks. Attention functioning was assessed using both objective and subjective tools three times: before the intervention (pre-test), after the intervention (post-test), and at follow-up (2-3 months later). Participants in the CPAT group exhibited significantly greater improvements in selective-spatial attention and in executive attention tasks (that were different than the attention training tasks) compared to participants in the CG group, and these gains were maintained at follow-up. These results provide strong evidence for near transfer effects of the CPAT. In addition, modest improvement in sustained attention was recorded in both training groups. However, analyses of the self-reported ADHD symptoms across the three points of assessment showed no change in either group. Future studies with larger samples should replicate and elaborate the present findings in order to assess whether the near transfer effects of the CPAT program could be translated to everyday functioning in high functioning adults with ADHD.

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What are the cognitive effects of stimulant medications? Emphasis on adults with attention-deficit/hyperactivity disorder (ADHD)

Cited by 190 publications

References 97 publications

Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury

Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury

Objective and subjective cognitive enhancing effects of mixed amphetamine salts in healthy people

Computerized Progressive Attention Training (CPAT) vs. Active Control in Adults with ADHD

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