A Multicenter, Randomized, Double-blind, Placebo-controlled Clinical Trial for Efficacy of Acetyl-L-carnitine in Patients with Dementia Associated with Cerebrovascular Disease

Abstract

Background and Purpose: Acetyl-L-carnitine (ALC) is a widely used drug for various neurodegenerative diseases including dementia. The aim of the present study was to elucidate the efficacy of ALC in dementia patients with cerebrovascular disease (vascular cognitive impairment; VCI). Methods: Fifty-six patients were randomized to treatment with 500 mg ter in die ALC, or placebo in this 28-week, double-blind, placebo-controlled trial. The primary outcome measure was the Korean version of Montreal Cognitive Assessment (MoCA-K). Results: Following treatment with ALC, the cognitive function measured by the MoCA-K was significantly improved in the ALC-treated groups. However, other secondary outcomes were not statistically significant between ALC-and placebo-treated groups. In MoCA-K analysis, attention and language sub-items significantly favored the ALC-treated group. Conclusions: Compared with placebo, treatment with ALC 1,500 mg/day produced significant changes in MoCA-K in dementia patients with VCI. ALC was well tolerated in this population. Despite the study limitations, the findings suggested the potential benefits associated with the use of ALC in dementia patients with VCI.

Acetyl-L-Carnitine in Dementia and Other Cognitive Disorders: A Critical Update

“…Therefore, a total of 37 papers were eventually included in the qualitative synthesis ( Figure 1), and the main findings are summarized in Table 1. In more detail, nineteen studies deal with AD or MCI [16,20,23,29,36,[39][40][41][42][43][44][45][46][47][48][49][50][51][52], three with vascular cognitive impairment (VCI) [53][54][55], five with HE [56][57][58][59][60], four with other secondary dementias [61][62][63][64], and six with an unspecified cognitive disorder [65][66][67][68][69][70]. The lowest dose of ALC did not produce changes.…”

“…Moreover, the authors did not report any side effect of ALC. In a very recent study [55], 56 patients with dementia and cerebrovascular disease participated in a multicenter, double-blind, placebo-controlled clinical trial and underwent randomized treatment comprising of ALC 1.5 g/day or placebo for 28 weeks. After ALC intake, the participants significantly improved in the score at the Montreal Cognitive Assessment, especially in the attention and language subitems.…”

“…After ALC intake, the participants significantly improved in the score at the Montreal Cognitive Assessment, especially in the attention and language subitems. However, the possibility that the study purely dealt with VaD is hard to consider since patients were already on donepezil, which means that a not negligible proportion might have been affected by AD or mixed dementia [55].…”

Neuroprotective Effects of Carnitine and Its Potential Application to Ameliorate Neurotoxicity

“…Within the first 3 months after initiation, daily supplementation of ALC (1.5–3 g/day, po 3–12 mo) to Alzheimer’s patients and patients suffering from mild cognitive impairment was associated with improved clinical scales and psychometric assessments measured by the Blessed Dementia Rating Scale (BDS), Global Deterioration Scale (GDS), Clinical Dementia Rating (CDR), etc . Additionally, dementia patients administered ALC (1.5 g/day, po 28 wks) daily showed improved clinical score of the Korean-Montreal Cognitive Assessment (MoCA-K) compared to placebo controls . Those suffering from major depressive disorder showed significantly reduced blood levels of carnitine compared to healthy controls in addition to other metabolites .…”

Vulnerable Strata to Non-Adherence and Overuse in Treatment for Patients with Cognitive Impairment

“…Because most patients are reimbursed for the drug by the National Health Insurance Service (NHIS), the prescriptions for choline alfoscerate, L-carnitine, and N-acetylcysteine have continuously increased. 6 7 Drug overuse for cognitive impairment (DOC), which is the excessive use of cognition-related drugs even though no impairment in their activities of daily living are being caused by cognitive decline, not only worsens the government's medical finances but also poses health threats caused by polypharmacy in patients with elderly cognitive impairment. Appropriate medication management is necessary for patients with and caregivers for cognitive impairment.…”