Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Eur Neurol 2011;66:7–13 DOI: 10.1159/000329275 Effect of Methylphenidate and/or Levodopa Combined with Physiotherapy on Mood and Cognition after Stroke: A Randomized, Double-Blind, Placebo-Controlled Trial Ahmad Delbari   a–c Reza Salman-Roghani   c Johan Lokk   a   a  Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; b  Sabzevar University of Medical Sciences, Sabzevar, and c  Iranian Research Center on Aging, University of Social Welfare and Rehabilitation, Tehran, Iran physiotherapy over a 3-week period was safe and signifi- cantly improved mood status in ischemic stroke patients. Future studies are needed which determine the optimal therapeutic window for and dosage of psychostimulants as well as identify those stroke patients who might benefit the most from treatment. Copyright © 2011 S. Karger AG, Basel Introduction The physical and psychological sequelae caused by stroke can be devastating [1]. Post-stroke depression (PSD) is the most common neuropsychiatric consequence of stroke [2] and affects 6–79% of stroke survivors [3]. Early recognition and effective treatment of PSD leads to more favorable functional and psychosocial outcomes and reduces disease burden as well as morbidity and mor- tality [4]. In a recent systematic review, Hackett et al. [5] reported that antidepressants could reduce mood disor- der symptoms among PSD patients but had no clear ef- fect on prevention or remission of depressive illness af- ter stroke. As deficits in central catecholamine levels are thought to play a major role in the etiology of PSD, en- Key Words Cognition  Mood  Rehabilitation pharmacology  Stroke Abstract Background/Aim: Stimulant medications can enhance mood and cognition in stroke rehabilitation, but human clin- ical trial results are inconclusive. We sought to prospectively study the effects of levodopa (LD) and/or methylphenidate (MPH) in combination with physiotherapy on mood and cog- nition following stroke in human subjects. Methods: Isch- emic stroke patients were enrolled in our study 15 to 180 days after stroke onset. The patients were randomized into four medication groups (MPH, LD, MPH + LD, or placebo) and received a 15-day course of medication therapy (1 dose daily) and 45-min standard physiotherapy treatment daily. Mood and cognitive function were assessed at the study onset and 15, 90 and 180 days after study enrollment. Results: The strongest improvement of mood and cognition was found between baseline and the first follow-up immediately after the intervention. A significant improvement in mood was also found in the combined treatment group (MPH + LD) at 90 and 180 days, compared to the placebo group. Conclu- sions: A 15-day course of daily MPH + LD combined with Received: November 3, 2010 Accepted: May 9, 2011 Published online: June 23, 2011 A. Delbari, MD, PhD, Division of Clinical Geriatrics Department of Neurobiology, Care Sciences and Society Huddinge Hospital, B 62 Karolinska Institute SE–14186 Stockholm (Sweden) Tel. +46 76 062 2003, E-Mail ahmad.delbari  @  ki.se © 2011 S. Karger AG, Basel 0014–3022/11/0661–0007$38.00/0 Accessible online at: www.karger.com/ene