Dysexecutive syndrome (DS) is characterized by impairments in executive function and emotional and behavioural disturbances. Available pharmacological interventions for cognitive enhancement, have limited efficacy in improving the symptoms while metylphenidate is known to be effective in Attention Deficit/Hiperactivity Disorder, a condition characterized, as in DS, by prefrontal cortico-subcortical dysfunction.

To report a case of successfull management of severe DS with methylphenidate.

Evaluate the effectiveness of methylphenidate on DS.

A 49-years-old male patient with severe vascular DS, was started on methylphenidate 10 mg daily (increased to 36 mg id).Patient was evaluated with Mini-Mental State (MMS), Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression (CGI) at T0 (before intervention), T1 (after 48 h), T2 (after 6 months) and T3 (after 18 months). Single photon emission computed tomography (SPECT) was undertaken at T0 and T3.

A rapid and sustained improvement was observed, with a 23% improvement in MMS), decrease of 83% in CGI and a 24.5% reduction in total BPRS, at T1 with beneficial effects persisting at T3. Brain SPECT at T3 revealed an improvement of perfusion deficits documented at T0.

Methylphenidate rapidly improved the symptoms of DS, and the effect persisted over 18 months with an associated improvement in brain perfusion.

Methylphenidate can thus be a promising therapeutic choice in cases of DS.