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TBI

1028 - Cognitive Gains; The Role of Creatine in Managing Traumatic Brain Injury

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST

    Co-Author(s)

  • KS

    Keyan Shasti, DO

    PGY2 Resident Physician
    MedStar Georgetown National Rehabilitation Hospital
    Ellicott City, Maryland, United States

  • RS

    Ravi C. Shah, DO

    PGY-1 Resident Physician
    BayCare St. Joseph's Hospital Tampa
    Lutz, Florida, United States

    • Presenting Author(s)

  • AA

    Andrew Abraham, DO

    Resident Physician
    The Wright Center
    Orlando, Florida, United States

    • Submitter(s)

  • AA

    Andrew Abraham, DO

    Resident Physician
    The Wright Center
    Orlando, Florida, United States

Objectives: Traumatic Brain Injury (TBI) affects nearly 69 million people worldwide each year, with an economic burden of about $80 billion in the United States. Its pathophysiology involves axonal injury, ionic flux, excitotoxicity, and energy crisis. Creatine, an amino acid like compound central to ATP regeneration, has emerged as a potential neuroprotective therapy. This study reviews experimental and clinical evidence on creatine’s role in TBI management.

Design: A focused literature review was conducted, analyzing animal studies on cortical injury and energy metabolism, as well as human trials and case series assessing functional, cognitive, and psychiatric outcomes following creatine supplementation

Results: In animal models, creatine pretreatment reduced cortical damage by up to 50% and attenuated oxidative stress, edema, and ATP depletion. In humans, pediatric and adolescent patients with severe TBI (GCS 3–9) who received 0.4 g/kg oral creatine within four hours of injury demonstrated significant improvements at 3- and 6-month follow-ups, including decreased headache, dizziness, and fatigue, as well as enhanced memory and abstract reasoning. Additional clinical evidence suggests creatine improves mood in patients with TBI-related depression, PTSD, and in those resistant to conventional antidepressants. Major barriers to broader clinical use include challenges in noninvasively measuring cortical bioenergetics and the limited accessibility of Proton-Nuclear Magnetic Resonance spectroscopy.

Conclusions: Creatine shows promise as an adjunctive therapy for TBI by stabilizing energy metabolism and supporting both cognitive and emotional recovery. While preclinical and early clinical data are encouraging, prospective studies are needed to determine optimal dosing strategies, therapeutic windows, and preventive applications in high-risk populations. Establishing creatine as part of TBI management could improve outcomes for millions affected by this condition.