CDP-Choline and Other Sources of Choline

Q. Dr. Dean,

Is your CDP-Choline a precursor to Acetylcholine and Phosphatidylcholine? Can I prescribe it to my patients taking neurotransmitter drugs, and will it be sufficient Choline?

Dr. Keith, Howard Beach, NY

A. Dear Dr. Keith,

CDP-choline is shorthand for cytidine-5’-diphosphocholine (it’s also known as citicoline). It is a chemical intermediate in the biosynthesis of two compounds that are very important for our brains: phosphatidylcholine and acetylcholine. As their names imply, these compounds are derived from the choline part of the CDP-choline molecule (the cytidine part plays no role in these processes).

Phosphatidylcholine (a lipid, or fatty compound) is the primary component of our cell membranes. Phosphatidylcholine is thus an integral part of all of our cells and is crucial for sustaining life. Acetylcholine is one of the brain’s (and body’s) primary neurotransmitters. It is the defining feature of the cholinergic system of neurons, which plays a central role in learning and memory.

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Among the hallmarks of brain aging are alterations in cell membranes and dysfunction of the cholinergic system. Supplemental CDP-choline has been shown to enhance memory function in elderly humans, especially those with memory impairment or outright dementia, such as Alzheimer’s disease. CDP-choline has long been used in Europe to treat cognitive, emotional, and behavioral deficits associated with chronic cerebral disorders in the elderly.

CDP-Choline Improves Memory in Elderly Patients

In a meta-analysis of clinical trials with CDP-choline, elderly patients suffering from cerebrovascular disorders, senile dementia (including Alzheimer’s disease), or normal or abnormal cognitive impairment associated with aging, were treated with dosages of CDP-choline ranging from 600–1000 mg/day. The researchers reported that CDP-choline caused modest but significant beneficial effects of memory function and behavior in these patients.3

To date there have been nearly 1000 papers published on CDP-choline. In more recent years, the studies have focused on the effects of CDP-choline on age-related cognitive decline (from which we all suffer) rather than more clearly defined degenerative diseases such as Alzheimer’s. Two of the significant categories for CDP-choline use are neuroprotection and stabilization of cell membranes,2 which are good ideas for those of us wanting to be around for some time. Also, CDP-choline has been successfully used to improve retinal and cortical responses in glaucoma.3

In a study published after the period of the meta-analysis, CDP-choline was given in amounts of 500–1000 mg/day for a period of 4 weeks to 24 elderly (mean age of 66 years) subjects with memory deficits and without dementia.4 In comparison with placebo, CDP-choline improved memory in free recall tasks but not in recognition tests. A significant improvement in word recall, immediate object recall, and delayed object recall was observed after the treatment.

The results suggest that CDP-choline possesses memory-enhancing activity at doses of 500–1000 mg/day. Also noted were decreases in systolic blood pressure and minor changes in lymphocyte counts. Thus CDP-choline appears to be a vasoregulator and neuroimmune enhancer. Its memory-improving mechanisms probably involve brain neurotropism and cerebrovascular regulation.

On the other hand, CDP-choline is about 35 times more expensive than Choline (as dihydrogen citrate), about which 10s of thousands of papers have been published. Some researchers think that it may work nearly as well in most instances, at 1⁄35 of the cost.

Ward Dean, M.D.

References

  1. Fioravanti M, Yanagi M. Cytidinediphosphocholine (CDP choline) for cognitive and behavioural disturbances associated with chronic cerebral disorders in the elderly (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. John Wiley & Sons, Chichester, UK.
  2. Davalos A. Neuroprotective agents. Neurologia 1999;14 Suppl 4:49-53.
  3. Parisi V, Manni G, Colacino G, Bucci MG. Cytidine-5’-diphosphocholine (citicoline) improves retinal and cortical responses in patients with glaucoma. Ophthalmology 1999 Jun;106(6):1126-34.
  4. Alvarez XA, Laredo M, Corzo D, Fernandez-Novoa L, Mouzo R, Perea JE, Daniele D, Cacabelos R. Citicoline improves memory performance in elderly subjects. Methods Find Exp Clin Pharmacol 1997 Apr;19(3):201-10.

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