Long‐term acetyl‐L‐carnitine treatment in Alzheimer's disease

Acetyl-L-carnitine (ALCAR) contains carnitine and acetyl moieties, both of which have neurobiological properties. Carnitine is important in the ␤-oxidation of fatty acids and the acetyl moiety can be used to maintain acetyl-CoA levels. Other reported neurobiological effects of ALCAR include modulation of: (1) brain energy and phospholipid metabolism; (2) cellular macromolecules, including neurotrophic factors and neurohormones; (3) synaptic morphology; and (4) synaptic transmission of multiple neurotransmitters. Potential molecular mechanisms of ALCAR activity include: (1) acetylation of -NH 2 and -OH functional groups in amino acids and N terminal amino acids in peptides and proteins resulting in modification of their structure, dynamics, function and turnover; and (2) acting as a molecular chaperone to larger molecules resulting in a change in the structure, molecular dynamics, and function of the larger molecule. ALCAR is reported in double-blind controlled studies to have beneficial effects in major depressive disorders and Alzheimer's disease (AD), both of which are highly prevalent in the geriatric population. Molecular Psychiatry (2000) 5, 616-632.

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“…Spangioli et al 99 conducted a multi-center study of 130 patients with probable AD. Family history of dementia was not given for the patients.…”

Section: Alcar's Neuroprotection Effect On Aging Processes and Relatementioning

confidence: 99%

Acetyl-L-carnitine physical-chemical, metabolic, and therapeutic properties: relevance for its mode of action in Alzheimer's disease and geriatric depression

2000

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“…We suggest alternative goals for therapy, but are aware that few of them are directly assessed by neuropsychological tests, although some are assessed by rating scales. [35][36][37] Level 1, Class C Lecithin 38,39 Level 1, Class C Arecholine 40 Level 1, Class C Nimodipine 41 Level 1, Class C Velnacrine 42 Level 1, Class D Physostigmine [43][44][45] Level 1, Class D Eptastigmine 46 Level 1, Class D Phosphatidylserine 47 Level 1, Class D Memantine 48 Level 1, Class D 4 Aminopyridine (4AP) 49 Level 1, Class D Naloxone 50 Level 1, Class D Linopirdine 51 Level 1, Class D Aniracetam 52 Level 1, Class D Milacemide 53 Level 1, Class D Nicergolin 54 Level 1, Class D Idebenone 55 Level 1, Class D Huperzine-A 56 Level 1, Class D 5'-methyltetrahydrofolic acid 57 Level 1, Class D Desferrioxamine 58 Level 1, Class D Xantinolnicotinate 59 Level 1, Class D Bespirdine 60 Level 1, Class D Cycloserine 61 Level 1, Class D Cyclandelate 62 Level 1, Class D Thyrotropin 63 Level 1, Class D…”

Section: Discussionmentioning

confidence: 99%

The Use of Medications for Cognitive Enhancement

Pryse-Phillips

Sternberg

Rochon

et al. 2001

Can. J. Neurol. Sci.

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Objective:To provide Canadian physicians and allied health care professionals with the evidence they need to help them make treatment decisions in the management of patients with Alzheimer’s disease or other dementias.Options:The full range and quality of diagnostic and therapeutic modalities available to Canadian physicians for the management of dementia.Outcomes:Improvement in the treatment of dementias, leading to reduced suffering, increased functional capacity and decreased economic burden.Evidence and values:The creation of these evidence-based consensus statements involved literature reviews of the subject by the authors; comparison of alternative clinical pathways and description of the methods whereby published data were analyzed; definition of the level of evidence for data in each case; evaluation and revision in a conference setting (involving primary care physicians, neurologists, psychiatrists, geriatricians, psychologists, consumers and other interested parties); insertion of tables showing key variables and data from various studies and tables of data with recommendations; and reassessment by all authors.Benefits, harms, and costs:A rational plan for the therapy of dementias is likely to lead to substantial benefits in both human and economic terms.Recommendations:Treatment decisions should be made taking into account the severity or stage of the disease, the availability of caregivers, the presence of disease affecting other bodily systems and the ability of the subject to pay the cost of the medications. Donepezil is considered to have positive effects upon certain tests of neuropsychological function and may produce some improvement in Alzheimer’s disease of mild to moderate severity as measured by rating scales. Its ability to improve quality of life remains uncertain. No other drug treatments* (apart from symptomatic therapies) are at present approved for the treatment of Alzheimer’s disease.Validation:These recommendations were created by a writing committee, evaluated and revised at a consensus conference and further reviewed and revised by the writing committee prior to publication.

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“…Overdosing can produce severe muscle weakness, though some have experienced only mild diarrhea with doses as high as 26,000 mg /day (David et al, 2000). With long-term (one year) administration, the most common adverse reactions noted have been agitation, nausea, and vomiting (Spagnoli et al, 1991).…”

Section: Adverse Effects Of Alcmentioning

confidence: 99%