Effect of CDP-choline on cognition and immune function in Alzheimer's disease and multi-infarct dementia

Cacabelos, Ramón; Alvarez, X.A.; Franco-Maside, A.; Fernández‐Novoa, L.; Caamaño, J.; Valle-Inclán, Fernando

doi:10.1016/0924-977x(92)90214-s

Cited by 14 publications

(15 citation statements)

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“…Citicoline has been used in a number of trials in patients with Alzheimer disease and has shown consistent but moderate improvement of memory and behavior. 33 However, a placebo-controlled trial of 30 patients with VaD showed no evidence of cognitive improvement. 34 A Cochrane review 35 included 14 studies on aged individuals with symptoms ranging from memory disorders to vascular mild cognitive impairment, VaD, or senile dementia.…”

Section: Citicoline In Stroke and Cognitive Declinementioning

confidence: 99%

Citicoline in Vascular Cognitive Impairment and Vascular Dementia After Stroke

Álvarez-Sabín

Román

2011

Stroke

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Abstract-Cognitive decline after stroke is more common than stroke recurrence. Stroke doubles the risk of dementia and is a major contributor to vascular cognitive impairment and vascular dementia. Neuropathological studies in most cases of dementia in the elderly reveal a large load of vascular ischemic brain lesions mixed with a lesser contribution of neurodegenerative lesions of Alzheimer disease. Nonetheless, few pharmacological studies have addressed vascular cognitive impairment and vascular dementia after stroke. Citicoline has demonstrated neuroprotective effects in acute stroke and has been shown to improve cognition in patients with chronic cerebrovascular disease and in some patients with Alzheimer disease. A recent trial lasting 6 months in patients with first-ever ischemic stroke showed that citicoline prevented cognitive decline after stroke with significant improvement of temporal orientation, attention, and executive function. Experimentally, citicoline exhibits neuroprotective effects and enhances neural repair. Citicoline appears to be a safe and promising alternative to improve stroke recovery and could be indicated in patients with vascular cognitive impairment, vascular dementia, and Alzheimer disease with significant cerebrovascular disease. Key Words: citicoline Ⅲ cognition Ⅲ dementia Ⅲ neuroprotection Ⅲ stroke complications Ⅲ stroke recovery Ⅲ vascular cognitive impairment Ⅲ vascular dementia S troke considerably increases the likelihood of dementia in the elderly. For instance, in the Framingham study, stroke doubled the risk of dementia. 1 Poststroke cognitive decline is more common than stroke recurrence. Poststroke vascular dementia (VaD) affects 30% of survivors, and the incidence of new-onset dementia increases from 7% 1 year after stroke to 48% after 25 years. 2 The term vascular cognitive impairment (VCI) 3 refers to the effects of the vascular burden of the brain on higher mental functions; VCI reflects all cognitive effects of cerebrovascular disease on cognition 4 and includes many types of cognitive impairment, except dementia (VCI with no dementia). 5 Patients with dementia as a result of hemorrhagic, ischemic, or hypoperfusive brain injury are included in the VaD category, 6 as are those with mixed vascular-degenerative forms.VCI with no dementia is twice as common as VaD. 7 Six months after stroke, 44% to 74% of patients present some degree of cognitive disturbance. 8 -16 Half of the patients with VCI have dementia develop within 5 years. 11 A recent meta-analysis of 16 studies 12 shows a clear relationship between stroke and dementia. Most of the studies agree that stroke doubles the risk of dementia independently of demographic data or presence of vascular risk factors. Preexisting cognitive impairment is not a determinant factor for the development of poststroke VCI. 17 The risk decreases over time after the index stroke event, but it seems to be higher in patients with the apolipoprotein E 4 allele, suggesting a link with Alzheimer disease.Cerebrovascular lesions, incl...

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Section: Citicoline In Stroke and Cognitive Declinementioning

confidence: 99%

Citicoline in Vascular Cognitive Impairment and Vascular Dementia After Stroke

Álvarez-Sabín

Román

2011

Stroke

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“…Of the studies using phosphatidylcholine, all those showing negative results used relatively low dosages. More recently, a study has been done using cytidine 5)-diphosphate choline, an intermediate in the choline-phosphatidylcholine pathway that the body efficiently absorbs as cytidine and choline [32]. This study showed promising results, improving mental performance in 60-80% of the patients.…”

Section: Discussionmentioning

confidence: 97%

Choline Is a Full Agonist in Inducing Activation of Neuronal Nitric Oxide Synthase via the Muscarinic M<sub>1</sub> Receptor

Carriere

El‐Fakahany²

2000

Pharmacology

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The present study was designed to characterize the interaction of choline with the M₁ subtype of the muscarinic acetylcholine receptor. Using Chinese hamster ovary cells transfected with neuronal nitric oxide synthase and the cloned human M₁ receptor (CHO hM₁/nNOS cells), we investigated choline’s effects on production of nitric oxide and elevation of intracellular [Ca²⁺]. Choline showed the properties of a full agonist in inducing the sustained plateau of increased intracellular [Ca²⁺], although it was only a partial agonist in inducing the larger, transient [Ca²⁺] peak. Choline was also found to act as a full agonist in stimulating the production of nitric oxide. These results have implications for efforts in the clinical treatment of dementia.

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“…• Métodos de neuroimagem (TC, RM -volume lesional, número e topografia das lesões, gravidade de leucoaraiose, grau de atrofia e dilatação ventricular) 7,9,20,76 • Eletrofisiológicos (EEG espectral, coerência eletrencefalográfica, eletro-oculografia, análise do ciclo sonovigília, potenciais cognitivos, potenciais motores) 1,19,23,35,44,45,48,67,72,76 • Bioquímicos e hormonais (interleucina-1, histamina, fator de necrose tissular, complexos imunes circulantes, alfa-1-antitripsina e alfa-2-macroglobulina, GH, PRL, androsterona, cortisol urinário; CRH, neuropeptídeos, endotelina-1 e colinesterase no LCR) 5,[11][12][13][14]37,47,57,58,71,82 • Neuropsicológicos (vários conjuntos de testes, baterias de testes, escalas de gravidade de demê-ncia) 6,8,26,35,53,59,60,67,68,79 • Provas funcionais (SPECT, PET, espectroscopia por RM) 10,20,21,49,50,81…”

Section: Tabela 1 Métodos Complementares Utilizados Em Estudos Recenunclassified

“…Um número muito pequeno de pacientes é habitualmente estudado, com divisões em subgrupos que tornam ainda mais difícil a interpretação dos resultados (p.ex. pentoxifilina 6 , citidina 29 , CDP-colina 13 , bifemelane 72 ). Como mencionado, uma miríade de métodos de avaliação de eficácia é utilizada, tornando difícil a comparação de diversas intervenções.…”

Section: Tratamento Medicamentoso Da Dvaunclassified

Demência vascular: dificuldades diagnósticas e tratamento

André

1998

Arq. Neuro-Psiquiatr.

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RESUMO -Justificativa: O tratamento dos pacientes com síndrome demencial depende do diagnóstico correto de sua etiologia e da utilização de critérios objetivos de avaliação do curso da doença. O diagnóstico preciso da demência vascular (Dva) é difícil e nossos conhecimentos sobre a organização neuropsicológica do cérebro em estados de doença e a evolução da doença são precários, tornando penosa a avaliação das respostas a diferentes intervenções. Métodos: São discutidos os critérios diagnósticos, os instrumentos de avaliação do curso da Dva e as diferentes intervenções terapêuticas atualmente em estudo. Resultados: O uso de critérios diagnósticos estritos e a otimização dos métodos de avaliação evolutiva são passos importantes para otimizar o tratamento dos pacientes com DVa. A prevenção de novos eventos cerebrovasculares é a única medida comprovadamente eficaz para promover estabilização e talvez regressão das alterações cognitivas e comportamentais nestes pacientes. As evidências de possível benefício de estimulantes inespecíficos do metabolismo cerebral e de drogas neuroprotetoras não são suficientes para indicar seu uso rotineiro. Medidas de estruturação do ambiente, o uso racional e parcimonioso de medicamentos em geral, e a definição através de testes neuropsicológicos de rotas terapêuticas adaptadas às necessidades de cada paciente são também importantes. Conclusões: Critérios diagnósticos e de acompanhamento evolutivo da DVa são ainda inadequados. A prevenção de novos episódios cerebrovasculares é a base do tratamento dos pacientes com DVa. O uso criterioso de drogas psiquiátricas, uma abordagem neurocognitiva dirigida aos déficits de cada paciente e a estruturação do ambiente para reduzir demandas desnecessárias e cansaço são importantes medidas complementares, mas deixam grande margem para otimização do tratamento. PALAVRAS-CHAVE: Isquemia cerebral, prevenção e controle; demência vascular, diagnóstico; demência vascular, reabilitação; demência vascular, tratamento medicamentoso. Vascular dementia: a critical review of diagnosis and treatmentABSTRACT -Background: Treatment of vascular dementia depends on accurate diagnosis and criteria for evaluation of therapeutic responses that are not well standardized. Methods: Diagnostic criteria for vascular dementia, tools for the assessment of its clinical course and current treatment options are sequentially reviewed. Results: Strict diagnostic criteria with high specificity should be selected in clinical trials. Tools for sequential assessment are not standardized. Clinical endpoints of real value for patients and caregivers are usually excluded from analysis. Prevention of recurrent cerebrovascular events is the only known treatment for stabilization and eventually recovery of cognitive and behaviour disturbances. Benefit may be obtained by adapting hospital or home environment and introducing daily routines minimizing stress and fatigue. The use of non-specific cerebral stimulants and so-called neuroprotective drugs is controversial. Careful neuropsychologic...

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Effect of CDP-choline on cognition and immune function in Alzheimer's disease and multi-infarct dementia

Cited by 14 publications

References 0 publications

Citicoline in Vascular Cognitive Impairment and Vascular Dementia After Stroke

Citicoline in Vascular Cognitive Impairment and Vascular Dementia After Stroke

Choline Is a Full Agonist in Inducing Activation of Neuronal Nitric Oxide Synthase via the Muscarinic M<sub>1</sub> Receptor

Demência vascular: dificuldades diagnósticas e tratamento

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