Memory training combined with the use of oral physostigmine

Impaired memory function is one of the most frequent and disabling symptoms observed after brain injury. A number of studies have examined the efficacy of using cholinergic agonists, such as physostigmine, in treating memory impairment resulting from various neurologic conditions. Few studies, however, have either combined the drug treatment with a memory training programme or monitored serum cholinesterase levels to increase the likelihood of achieving a therapeutic dose of the medication. The current study addresses both of these issues. Two single-case studies are reported in this investigation. In each case, a double-blind, placebo-controlled, single-subject, A-B-A design was used with A representing the base-line phases, B constituting the memory training combined with medication phase and A representing the return to base-line condition. Both patients sustained anoxia as a result of carbon monoxide poisoning. In the first case, a clinically significant improvement was seen in the patient's performance of both standardized and non-standardized measures of memory function as a result of the combined treatment regimen. No significant changes, however, were seen in the patient's performance on measures of attention and concentration, cognitive flexibility or motor speed. These findings were then replicated with the second anoxic patient. The results from this study point out the potential benefit of combining cholinergic agonists with specific memory training strategies in improving memory function after brain injury.