Caroline Cassels

August 01, 2012

August 1, 2012 (Vancouver, British Columbia) — The dietary supplement citicoline, which is sold over the counter in 70 different countries, including the United States, appears to help memory in patients with vascular mild cognitive impairment (VaMCI) and may hinder cognitive deterioration, new research suggests.

Preliminary results from a longitudinal study presented here at the Alzheimer's Association International Conference (AAIC) 2012 showed that at 9 months, there was a significant difference in Mini–Mental State Examination (MMSE) scores in citicoline users vs nonusers.

"If we compare the citicoline group with the nontreatment group, there was a statistically significant difference [in MMSE scores]. On the other hand, we also saw a small increase in activities of daily living [ADL], but this was not statistically significant," principal investigator Pietro Gareri, MD, PhD, Ambulatory Center for Dementia, Catanzaro, Italy, told Medscape Medical News.

Dr. Pietro Gareri

The investigators note that vascular disease can impair cognition by reducing cerebral perfusion, causing oxidative stress and neurodegeneration.

Research has also shown that vascular dementia, which is the second most common form of dementia, can accelerate atrophy, resulting in white matter abnormalities, asymptomatic infarct, inflammation, and reduced glucose metabolism, cerebral blood flow, and vascular density.

Such brain changes, said Dr. Gareri, can have a significant impact on ADL.

Acetylcholine Precursor

A psychostimulant, citicoline has been shown to inhibit brain cell death associated with cerebral ischemia. It has also been shown to inhibit neurodegeneration and is able to increase neuroplasticity and noradrenaline and dopamine levels in the central nervous system.

Furthermore, said Dr. Gareri, it serves as a choline source in the metabolic pathways for the biosynthesis of acetylcholine. In addition, pharmacokinetic studies suggested that it is well absorbed and highly bioavailable with oral dosing.

To assess the safety and efficacy of citicoline in elderly individuals with VaMCI, the investigators conducted a multicenter study of 349 participants — 265 in the active treatment group and 84 control participants — aged 65 years and older who had an MMSE score of ≥21, or subjective memory complaints with no evidence of deficits on MMSE, or evidence of vascular lesions on neuroradiology.

Those in the active treatment group received oral citicoline at a dose of 500 mg twice a day.

Study outcomes included improvement in MMSE scores, ADL, and instrumental activities of daily living (IADL) compared with control participants.

Mood was measured using the geriatric depression scale (GDS), and behavioral disorders were assessed by use of the Neuropsychiatric Inventory scale.

All participants underwent brain imaging by computerized tomography or magnetic resonance imaging. In addition, they underwent assessment of vitamin B12 and folate levels and thyroid function at baseline and at 3, 6, and 9 months.

Boost in Mood

The researchers found that after 9 months, those in the active treatment group showed a slight but nonsignificant benefit in MMSE scores (22.4 at baseline, 22.9 after 9 months).

However, for those in the untreated control group, MMSE scores declined (21.5 at baseline, 19.6 at 9 months), and this difference was statistically significant.

The researchers found no difference between the 2 groups in ADL and IADL scores. In addition, no adverse events were recorded.

Dr. Gareri noted that with regard to secondary outcomes of mood and behavior, there was a rise in GDS scores in the citicoline group, although this also was not statistically significant.

"This study showed that citicoline is effective and well tolerated in mild vascular cognitive impairment," said Dr. Gareri in a statement. "When cognitive testing scores over 9 months remain unchanged in people developing cognitive impairment, we think this may be considered a good outcome."

These findings, he added, indicate that citicoline is safe and efficacious. However, he said, further research is needed. Among other potential hypotheses, Dr. Gareri said it would be interesting to examine whether citicoline could delay the time to treatment with a prescription medication.

Need for Replication

Commenting on the study for Medscape Medical News, Ralph Nixon, MD, PhD, chair of the Alzheimer's Association Medical and Scientific Advisory Council, said the findings are "encouraging," but noted that they are preliminary.

Dr. Ralph Nixon

"A lot more work [is needed] before we can even suggest it can be used for vascular dementia, even though it is available for that purpose," said Dr. Nixon. A lot of agents have been touted as doing something positive and although many are innocuous, some are not.

"In reality, we know relatively little about vascular dementia and how to treat it. The long-term consequences of giving even a neutraceutical type of preparation are unclear. If this [research] group is encouraged by the results, we expect to see replication of the findings and further validation before we know whether it is acceptable or even advisable to use it," he said.

Dr. Gareri and Dr. Nixon have disclosed no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2012. Developing Topics Sessions Presentation 04-12-05. Presented July 18, 2012.

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