Question 5

Questions 4 & 5 Refer to the Following Case:

A 25-year-old computer programmer is referred for neurologic consultation 3 months after he sustained a moderately severe closed head injury after falling off a bicycle. After improving over the prior 3 months, the patient has made an attempt to return to working. However, he complains that he is unable to sustain his work even half time. His primary difficulty is that he feels “foggy” and unable to maintain concentration after 2 hours of work, and this is particularly a problem after meetings.


Even with improvement in his fatigue, the patient continues to have residual cognitive dysfunction that prevents him from reaching his goal of returning to work. The patient is working with a rehabilitation therapist to learn strategies for improving his daily functioning given deficits in long-term memory. However, the therapist is concerned that poor attention contributes not only to the patient’s memory deficits, but also reduces the benefits of the rehabilitation sessions. He also notes that the patient is anxious and easily frustrated during sessions. The therapist asks whether any pharmacotherapy options might contribute to therapy goals at this chronic stage of recovery. The neurologist suggests a cholinesterase inhibitor with the goal of augmenting attention and learning during therapy sessions. What potential medication side effects might actually impede participation?