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α-GPC + CDP-Choline (Citicoline)
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In one pass α-GPC and CDP-choline (citicoline) are two choline supplements sold for the brain. Not this — α-GPC / CDP-choline = nootropic for healthy adults — A single dose shows no reliable thinking or memory benefit in healthy adults; long-term human data is thin.
Educational content, not medical advice — consult a clinician.
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Chapter 1
Two choline derivatives
α-GPC and CDP-choline (citicoline) are two choline supplements sold for the brain. Think of them as brain-bound versions of ordinary choline, pitched as better at getting into the brain. In Europe and Japan they are prescription drugs, given to people with dementia or with cognitive decline after a stroke; in the US and China they sit on the brain-supplement shelf.
Why get into the brain? The brain uses a signal molecule called acetylcholine (ACh) for memory, and also to tell muscles to fire, and its raw material is choline. Choline first has to squeeze from the blood through the blood–brain barrier, the sieve between blood and brain. These two forms are thought to get through more easily, and part of what gets in can go straight into making acetylcholine.
The evidence differs a lot by use. Chronic recovery after a stroke and vascular cognitive impairment have some positive trials; for healthy people taking them to boost the brain, the evidence is thin. A Korean national cohort also found more strokes later among people who had used α-GPC. That is an observed association, and it cannot separate the drug from the disease. Neither is an emergency treatment: if a stroke is starting (weakness on one side of the body, a drooping mouth, slurred speech), call emergency services at once.
Why get into the brain? The brain uses a signal molecule called acetylcholine (ACh) for memory, and also to tell muscles to fire, and its raw material is choline. Choline first has to squeeze from the blood through the blood–brain barrier, the sieve between blood and brain. These two forms are thought to get through more easily, and part of what gets in can go straight into making acetylcholine.
The evidence differs a lot by use. Chronic recovery after a stroke and vascular cognitive impairment have some positive trials; for healthy people taking them to boost the brain, the evidence is thin. A Korean national cohort also found more strokes later among people who had used α-GPC. That is an observed association, and it cannot separate the drug from the disease. Neither is an emergency treatment: if a stroke is starting (weakness on one side of the body, a drooping mouth, slurred speech), call emergency services at once.
Mechanism · Start with ordinary choline
To see where these two stand out, start with ordinary choline. Choline is an essential nutrient the body cannot do without (the US adequate intake, : 550 mg/day for men, 425 for women). It holds several jobs: it is built into the phospholipids of cell membranes, it is used to make the nerve signal molecule acetylcholine (ACh), it feeds a side pathway that moves methyl groups around, and it helps the liver ship fat out. The brain-boost claim is mostly about the acetylcholine job: the messenger that handles memory in the brain and also tells muscles to fire.Mechanism · How the two forms differ
α-GPC (alpha-glycerylphosphorylcholine) and CDP-choline each play the brain job differently. α-GPC already occurs in breast milk and in the brain; 40% of the molecule is choline, and part of it can be used directly as raw material for acetylcholine. It is thought to cross the blood–brain barrier (the sieve between blood and brain) easily, so it arrives fast. In some European countries it is a prescription drug for dementia and for cognitive recovery after a stroke; in the US and China it is sold on the brain-supplement shelf. CDP-choline (also called citicoline) is an intermediate the body makes while building phospholipids: only 18% choline, paired with 32% cytidine. It also gets into the brain well, and it is a prescription drug in Japan and Europe. Supplement versions often use a high-purity grade called Cognizin, which is what a good number of cognition trials used.In practice · Is the extra cost worth it
Compared with cheap ordinary choline (choline bitartrate, or the phosphatidylcholine in lecithin), is the extra money worth it? Ordinary choline is the all-purpose top-up that the liver, heart and brain can all use, and it is the best value. α-GPC and CDP-choline are thought to deliver choline to the brain more precisely, at a higher price, and what that buys a healthy person is thinly supported. One thing none of the three forms escapes: when you take in a lot of choline, gut bacteria turn part of it into trimethylamine (TMA), which the liver then oxidizes into a metabolite called trimethylamine N-oxide (TMAO). In some observational studies TMAO is associated with cardiovascular risk, and people differ a great deal; the story on choline covers TMAO in detail.Safety · A stroke signal that cannot be settled
What makes people stop and think is a newer safety signal. Lee 2021 followed 12 million people aged 50 or older in Korea and found more later strokes among those who had used α-GPC (an adjusted , aHR, of 1.43 for all strokes, or about 40% higher), with the signal stronger the longer they used it. But do not rush to a verdict. In Korea its insurance indications are broad, and many older people are prescribed it to ward off cognitive decline even without dementia; the users were older, had more other illnesses, and may already have had undetected hardening of the arteries. These are observational data, and they cannot tell whether it is the drug or the disease.Chapter 2
Which conditions have evidence
What these two supplements can and cannot do has to be sorted by use, and several uses tell the same story: small early trials look promising, and large, rigorous trials come up empty.
For CDP-choline as a rescue treatment in the first hours of an acute ischemic stroke, the largest trial so far (ICTUS) was negative, and traumatic brain injury gave the same result. The chronic stage looks somewhat better: a review (Alvarez-Sabín 2011) considers CDP-choline promising for cognitive decline after a stroke, and α-GPC combined with a standard Alzheimer's drug has some positive results. But neither can replace standard treatment; they can only be added to it. Giving them to healthy people as a brain supplement is where marketing is loudest and evidence thinnest. On exercise, a few small trials report slightly higher force output after taking α-GPC before training, which still needs larger trials to confirm.
There is also a stroke signal that cannot be ignored: in a Korean national cohort, people who had used α-GPC had more strokes later. The key to reading it is a trap called by indication: the same disease may both get someone the prescription and cause the stroke.
For CDP-choline as a rescue treatment in the first hours of an acute ischemic stroke, the largest trial so far (ICTUS) was negative, and traumatic brain injury gave the same result. The chronic stage looks somewhat better: a review (Alvarez-Sabín 2011) considers CDP-choline promising for cognitive decline after a stroke, and α-GPC combined with a standard Alzheimer's drug has some positive results. But neither can replace standard treatment; they can only be added to it. Giving them to healthy people as a brain supplement is where marketing is loudest and evidence thinnest. On exercise, a few small trials report slightly higher force output after taking α-GPC before training, which still needs larger trials to confirm.
There is also a stroke signal that cannot be ignored: in a Korean national cohort, people who had used α-GPC had more strokes later. The key to reading it is a trap called by indication: the same disease may both get someone the prescription and cause the stroke.
Clinical · Acute stroke and brain injury
Stroke first. CDP-choline as a rescue treatment in the first hours of an acute ischemic stroke once carried high hopes. But the largest trial so far (ICTUS, N = 2,298, patients with moderate to severe stroke, started within a day of onset, 2000 mg a day for 6 weeks) was stopped early for futility: overall recovery at three months was similar in the two groups (, OR, 1.03, which means almost no difference). Some prespecified subgroups showed scattered hints in a positive direction, but the main result was negative, and hints like these cannot be taken as conclusions. So its current place is: not recommended in the acute phase, while a few hospitals still use it in chronic rehabilitation. Traumatic brain injury follows the same script: the largest trial (COBRIT, N = 1,213, 90 days of treatment) also found no functional improvement.If a stroke is starting (weakness on one side of the body, a drooping mouth, slurred speech), call emergency services at once: clot-dissolving drugs and clot removal are both a race against time, and supplements cannot help.
Clinical · Dementia and vascular cognitive impairment
Dementia and vascular cognitive impairment look a little brighter. The review by Alvarez-Sabín 2011 considers CDP-choline promising for cognitive decline after a stroke: it cites a 6-month trial in people with a first ischemic stroke in which the treated group declined less, with improvements in orientation to time, attention and executive function. Such trials are few, the certainty of evidence is low to moderate, and more independent trials are needed.In Alzheimer's disease, one double-blind multicenter trial (ASCOMALVA, as described in the Lee 2021 paper) found in patients who also had cerebrovascular damage that donepezil plus α-GPC may slow decline more than donepezil alone. On its own, α-GPC cannot replace a standard cholinesterase inhibitor (donepezil and similar drugs); it is an add-on only.
Evidence · Healthy brains and training output
Giving it to healthy people as a brain supplement is marketing's main battlefield, and yet the evidence there is thinnest. The trials mostly have fewer than 100 people and results that go both ways, and reviews point out high heterogeneity and funding that often comes from the supplement industry; the certainty of evidence is low.There is somewhat more on the exercise side: a few small trials report that a single 600 mg dose of α-GPC before training slightly raised force output over the short term. The mechanism suggests that a little more acetylcholine (the messenger that tells muscles to fire) may make conduction from nerve to muscle crisper; that step has not been measured directly, the trials are all small, and they need repeating.
Evidence · The Korean national cohort in numbers
The stroke signal still cannot be avoided. Lee 2021 used Korea's national health insurance data on 12 million people aged 50 or older with no prior stroke or Alzheimer's disease (108,877 of them α-GPC users). It looked at who was prescribed the drug in the first few years, then followed people for about ten more years to see who had a stroke. After matching for age, sex, income and other illnesses, users had about 40% higher risk of any stroke (adjusted , aHR, 1.43, 95% 1.41–1.46, meaning the true value very likely lies in that range), 1.34 for ischemic stroke and 1.37 for hemorrhagic stroke. Compared with people prescribed it for less than 2 months, the longer the use, the clearer the signal (2–6 months 1.13, 6–12 months 1.18, over 12 months 1.36).Evidence · The trap of confounding by indication
How should the signal be read? The authors themselves suggest that TMAO (the metabolite gut bacteria make from choline) may be one route, but the study did not measure TMAO. The bigger problem is a trap that cannot be avoided. In Korea, the insurance indications for α-GPC include dementia, secondary symptoms of cerebrovascular disease, changes in mood and behavior, and depression in old age, and many older people are prescribed it to ward off cognitive decline even without dementia. Yet cognitive decline can itself be the brain's blood vessels sounding an alarm. The authors also wrote that users were older, had more other illnesses and may already have had hidden atherosclerosis; they excluded people with transient ischemic attacks and matched the groups, but matching cannot catch vessel disease that was never diagnosed. This is by indication: observational data cannot tell whether the drug harmed people or whether the same disease both got them the prescription and gave them the stroke. So the real conclusion is not α-GPC will give you a stroke. It is that healthy people have little benefit to gain, and it is not worth betting on a signal that cannot be settled.Mechanism · Where it meets other choline pathways
At high doses, part of any form of choline is turned by gut bacteria into trimethylamine (TMA), which the liver then converts into trimethylamine N-oxide (TMAO). Protecting the liver and shipping fat out rely mainly on ordinary choline; α-GPC and CDP-choline lean toward the brain. As for the methylation side pathway, choline is first turned into betaine (), and then an enzyme called BHMT (betaine– methyltransferase) hands off a methyl group, turning homocysteine back into methionine. The stories on choline and on betaine cover these side roads in detail.Chapter 3
Comparing choline forms
Which choline to pick comes down to two things: what share of a capsule is actually choline, and how well that choline can squeeze through the blood–brain barrier (, the sieve between blood and brain) into the brain.
The cheap two, choline bitartrate and the phosphatidylcholine (PC) in lecithin, are thought to get through that sieve only moderately well. They work more like a supply for the whole body: the liver shipping fat out and cell membranes renewing themselves both depend on them. The expensive two are thought to deliver the goods to the brain's door: α-GPC wins on choline content, and CDP-choline brings a cytidine along. That is why they have been tested for cognition after stroke, as an add-on in dementia and for force output before training; but in healthy people, the evidence for what the expensive two buy you is thin.
If your only problem is too little choline in your diet, eggs, organ meats and fish, plus cheap ordinary choline, are enough.
The cheap two, choline bitartrate and the phosphatidylcholine (PC) in lecithin, are thought to get through that sieve only moderately well. They work more like a supply for the whole body: the liver shipping fat out and cell membranes renewing themselves both depend on them. The expensive two are thought to deliver the goods to the brain's door: α-GPC wins on choline content, and CDP-choline brings a cytidine along. That is why they have been tested for cognition after stroke, as an add-on in dementia and for force output before training; but in healthy people, the evidence for what the expensive two buy you is thin.
If your only problem is too little choline in your diet, eggs, organ meats and fish, plus cheap ordinary choline, are enough.
Numbers · Six forms side by side
Six choline-related forms compared:| Form | Choline % | BBB | Price | Main use |
|---|---|---|---|---|
| Choline bitartrate | 41% | medium | $ | Whole-body top-up when food falls short |
| Phosphatidylcholine (PC, lecithin) | 13% | medium | $$ | Cell membranes, liver and gut |
| Citicoline (CDP-choline) | 18% | high | $$$ | Cognition after stroke; brain supplement |
| α-GPC | 40% | high | $$$ | Dementia add-on, exercise performance, brain supplement |
| N-acetylcysteine (NAC) | not applicable | high | $ | Not a choline form, but often taken with choline |
| Dimethylaminoethanol (DMAE) | not applicable | high | $$ | Old brain supplement, weak evidence |
Key: the column is a relative description of how well each crosses the blood–brain barrier, not a measured percentage; the number of $ signs shows relative price.
In practice · Brand grades and third-party marks
Purity and quality:Cognizin (a commercial grade of CDP-choline, from Kyowa Hakko in Japan): used in a good number of randomized trials, with documented purityAlphaSize (a commercial grade of α-GPC, from Chemi Nutra in the US): soy-derived and used in some randomized trialsThird-party certification (USP, NSF, Informed-Choice) is the minimum standard for quality
In practice · How much for which job, how soon
Dose:CDP-choline: 250–500 mg twice a day for brain use; 2000 mg a day was the dose in the ICTUS acute-stroke trial, whose overall result was negativeα-GPC: 300–600 mg/day for brain use; 1200 mg/day for dementia, in divided dosesExercise performance: α-GPC 600 mg, 30–60 minutes before trainingFood (eggs, organ meats, fish): ordinary choline is enough, and you do not need α-GPC or CDP-choline
How soon (mostly rules of thumb, not figures set by trials):
Exercise performance (α-GPC): one dose, 30–60 minutesBrain use: 1–4 weeks to feel it subjectively, 4–12 weeks on objective testsCognition after stroke: reassess at 3–6 months
In practice · Combining with other brain supplements
Taking it with other brain supplements:Caffeine with theanine: often used together; the story on caffeine and L-theanine explains how the two work togetherBacopa (Bacopa monnieri): an Ayurvedic herb with randomized trials showing small gains in learning and reaction speed after 12 weeks of daily useLion's mane: rests on a hypothesis about nerve growth factors, with human evidence from small samplesModafinil and amphetamines (such as Adderall): prescription drugs, not supplements; stacking them with supplements carries real risk
Safety · Side effects and who should skip it
Safety:Common side effects: nausea, headache, insomnia, and a racing heart at high dosesTMAO: worth watching with long-term high dosesMood: some people feel more anxious and irritable on α-GPCPregnancy and breastfeeding: no data (choline from food is safe; skip the supplement)Children: not recommended unless there is a clear medical reason
Contraindications and warnings:
Bipolar disorder: α-GPC or CDP-choline may trigger or worsen mania; use with cautionTaking a selective serotonin reuptake inhibitor (, a common class of antidepressants) or an anticholinergic drug: risk of interactionsHigh risk of heart and blood vessel disease: keep the Lee 2021 stroke signal in mindStop 1 week before surgery: some worry about an effect on clotting
Myth · The one-week brain boost pitch
The focus-miracle pitch, point by point:Claims like one week and your brain power soars are mostly the placebo effectThe real effect is mild, and people differ a lotThe levers that actually improve focus are sleep, exercise, nutrition, less screen time and less stress; no supplement beats them
Chapter 4
Should you take it, and which
Before deciding whether to take them, ask yourself one question: what problem are you trying to solve?
You are healthy and want better focus and memory. This is the box with the smallest payoff. If you want to try, try it briefly, and stop if neither how you feel nor an objective test improves. Before paying, weigh this: enough sleep, moving your body, and cutting back on screens and stress usually do more for the same person than any bottle, and they cost nothing.
You already have a clear medical reason, such as chronic recovery after a stroke, vascular cognitive impairment, an add-on in dementia, or a boost before strength training. Only then does choosing a form and dose come in. The first three should be decided together with a neurologist, and the supplement does not replace standard treatment.
A stroke is starting. If there is weakness on one side of the body, a drooping mouth or slurred speech, call emergency services at once. Clot-dissolving drugs and clot removal are a race against time; these two supplements were negative in the large acute-phase trials, so do not use them in place of emergency care.
You are healthy and want better focus and memory. This is the box with the smallest payoff. If you want to try, try it briefly, and stop if neither how you feel nor an objective test improves. Before paying, weigh this: enough sleep, moving your body, and cutting back on screens and stress usually do more for the same person than any bottle, and they cost nothing.
You already have a clear medical reason, such as chronic recovery after a stroke, vascular cognitive impairment, an add-on in dementia, or a boost before strength training. Only then does choosing a form and dose come in. The first three should be decided together with a neurologist, and the supplement does not replace standard treatment.
A stroke is starting. If there is weakness on one side of the body, a drooping mouth or slurred speech, call emergency services at once. Clot-dissolving drugs and clot removal are a race against time; these two supplements were negative in the large acute-phase trials, so do not use them in place of emergency care.
Clinical · Three situations with a medical reason
Deciding on α-GPC or CDP-choline:Question 1: what is your goal?
A. Acute stroke (the emergency phase):
Not recommended (the two large randomized trials, ICTUS and COBRIT, were both negative)Standard stroke care comes first (clot-dissolving drugs and clot removal, plus antiplatelet drugs and secondary prevention); call emergency services as soon as symptoms appear
B. Chronic recovery after a stroke, vascular cognitive impairment:
CDP-choline 500–1000 mg/day, to be discussed with a neurologistSupported by some trials, with low-to-moderate certainty of evidence; assess at 6 months
C. An add-on in Alzheimer's disease (already taking a cholinesterase inhibitor):
α-GPC 600–1200 mg/day, to be discussed with a neurologistIt does not replace donepezil or memantine
In practice · Healthy people and training
D. Brain boost for healthy people (attention, memory):The smallest returnTry it for 4–8 weeks, check for subjective and objective improvement, and stop if there is noneCDP-choline 250 mg twice a day, or α-GPC 300 mg/dayValue for money: caffeine with theanine, sleep and exercise all do better
E. Exercise performance (strength training):
α-GPC 600 mg before trainingSupported by a few small trials; reasonable to tryDo not take a high daily dose for a long time (the Lee 2021 stroke signal)
In practice · Can food do the job instead
Question 2: can food and ordinary choline do the job?If you eat enough egg yolks, organ meats and fish, most people get enough cholineRely on diet first; if it falls short, 250–500 mg of choline bitartrate or 1–2 g of phosphatidylcholine a day fills the gap (the same figures as in the story on choline)Keep the brain-leaning forms (α-GPC, CDP-choline) for a real medical reason
Question 3: warnings and contraindications:
High risk of heart and blood vessel disease, planning long-term use: the Lee 2021 stroke signal calls for cautionBipolar disorder, anxiety: some people get worsePregnancy, breastfeeding, children: skip itTaking an or an anticholinergic drug: talk to your doctor firstConcerned about TMAO, or already have cardiovascular disease: monitor
Question 4: cost and realistic expectations:
It costs clearly more than ordinary cholineCompared with prescription alertness drugs (modafinil and the like): the prescription drugs act more strongly but carry dependence and side effectsCompared with lifestyle: sleep, exercise and nutrition are the stronger brain boosters
In practice · The levers people skip
The brain levers people most often skip:1. Sleep 7–9 hours: the most powerful single item
2. Exercise: raises BDNF (a growth factor that helps the brain lock in memories) and blood flow to the brain
3. Less screen time and less social media: in effect, attention training
4. Diet (less ultra-processed food, a Mediterranean-style pattern): chronic inflammation comes down
5. Mindfulness and meditation: attention and working memory
6. Drink less alcohol
7. Manage stress: long-running chronic stress wears on the brain
8. Learn new skills and spend time with people: neural plasticity
These levers cost close to 0 and do not carry supplement-style side effects, and together they do far more than any brain supplement.
Evidence · How much evidence brain boosters have
Most brain supplements on the market are over-marketed. By how much evidence they have, they fall roughly into a few tiers:The tier with more evidence (several randomized trials, or many studies agreeing):
Caffeine 50–200 mg: attention, reaction time, alertness; the one with the most evidence (the story on caffeine and L-theanine covers it in detail)Theanine 100–200 mg with caffeine: often used together (less of the jitteriness coffee brings, more focus)Sleeping 7–9 hours: the most powerful single item, which no supplement can replaceExercise (30 minutes of moderate aerobic activity): raises BDNF, blood flow to the brain and neural plasticityMeditation and mindfulness: working memory and attention (a 2015 by Tang)
The tier with moderate-to-low evidence (a number of small to medium randomized trials; helps some people):
Citicoline (CDP-choline) 500–1000 mg: cognition after stroke, add-on in dementia (covered in the earlier chapter on clinical evidence)Bacopa 300 mg: small gains in learning and reaction speed after 12 weeks of daily use (Kongkeaw 2014 meta-analysis); an Ayurvedic herbRhodiola 200–400 mg: less fatigue, better performance under stress (Panossian 2010)Ashwagandha 300–600 mg: stress, anxiety, sleep (Chandrasekhar 2012)Glycine 3 g at bedtime: better sleep by self-report, which helps daytime brain power indirectlyOmega-3 ( and ): a signal of long-term cognitive protection (not an acute effect)
Low evidence:
Lion's mane (Hericium erinaceus) 1–3 g: a hypothesis about nerve growth factors; in people, one small trial in mild cognitive impairment (Mori 2009)
mori-2009-lions-mane-rct
Evidence · Weak evidence and pure marketing
Weak evidence, mostly commercial:α-GPC: weak evidence for healthy people, plus the stroke signal (Lee 2021)Piracetam, aniracetam, oxiracetam: old brain drugs, prescription-only in Europe and China, with weak clinical benefitModafinil: a prescription drug for narcolepsy and the excessive sleepiness of shift-work sleep disorder; use outside those indications is popular but carries dependence and cardiovascular risksPhenibut: an analog of (the signal that quiets neurons) that is addictive, with withdrawal on stopping; not recommendedDimethylaminoethanol (DMAE): an old brain supplement with weak evidencePRL-8-53: a single trial from 1978, never reproduced
Pure marketing (not recommended):
"Brain gold" products: mostly omega-3 in gimmicky packagingMulti-ingredient brain products sold under various brand names in China: weak signalBrain-training games (such as Lumosity): in 2016 the US Federal Trade Commission (FTC) fined the maker $2 million over its claims to improve the brain; there is no evidence that it improves the brain, : anti-aging marketing; no randomized trial in people has shown them to improve cognition (the story on NMN and NR covers this in detail)
Improving focus, ranked by real effect:
1. Sleep, exercise, less social media, meditation: nearly free, without supplement-style side effects, and the strongest effect
2. Caffeine with theanine: cheap, works the same day
3. Environment: quiet, one task at a time, fewer notifications
4. Diet: a Mediterranean-style pattern, less ultra-processed food, enough protein
5. (An optional trial) brain supplements with moderate-to-low evidence: bacopa, rhodiola, citicoline
6. (With a clinical indication) prescription drugs: after a diagnosis of attention-deficit/hyperactivity disorder (ADHD)
Find me a supplement that makes me focus is the wrong question to begin with. Attention, memory and thinking are outputs of overall brain health, not products of a single neurotransmitter. Getting the 4 foundations of sleep, exercise, nutrition and mental health to about 80% pays back far more than any brain supplement.
Worried about cognitive decline and hoping a brain supplement will slow aging:
The levers that genuinely help prevent cognitive decline: controlling blood pressure and blood sugar, quitting smoking, exercise, education, social contact, hearing aids when hearing declines, drinking less alcohol, and treating depressionLivingston 2024 (a Lancet Commission report) lists 14 modifiable risk factors (including those above, plus high (low-density lipoprotein cholesterol, often called bad cholesterol), uncorrected vision loss, air pollution and others) and estimates that about 45% of dementia worldwide is linked to them and could in theory be prevented or delayed. That is a population-level estimate; it does not mean one person who follows it all lowers their own risk by 45%No brain supplement comes anywhere near that scale
Background · How this links to other topics
How this topic connects to others:Choline metabolism upstream: ordinary choline, and the methylation side road through betaine ()Often used together with it: caffeine with theanineMethylation: vitamin B12, folate and one-carbon metabolismAcetylcholine and the synapse: signal transmission in the nervous systemThe foundations of brain health: depression and anxiety, sleep apnea, insomnia
To settle it: α-GPC and CDP-choline are the two biggest choline-derived molecules on the brain-supplement market. Their real indications (cognition after stroke, an add-on in dementia, before strength training) have some trial support; the evidence for boosting healthy brains is weak, and long-term use carries a stroke signal that cannot be settled. No scaremongering and no promises of perfection: here is the full information, and the decision is yours.
References · 7
- Alvarez-Sabín, J., & Román, G. C. (2011). Citicoline in vascular cognitive impairment and vascular dementia after stroke. Stroke, 42(1 Suppl), S40-S43. 10.1161/STROKEAHA.110.606509
- Dávalos, A., Alvarez-Sabín, J., Castillo, J., Díez-Tejedor, E., Ferro, J., Martínez-Vila, E., et al. (2012). Citicoline in the treatment of acute ischaemic stroke: an international, randomised, multicentre, placebo-controlled study (ICTUS trial). The Lancet, 380(9839), 349-357. N=2298; 2000 mg/day × 6 weeks; stopped for futility; global recovery OR 1.03 (0.86-1.25). Moderate-to-severe acute ischaemic stroke: citicoline or placebo started within 24 h (1000 mg every 12 h IV for 3 days, then oral) for 6 weeks, 1148 vs 1150 patients at 59 centres in Spain, Portugal and Germany; stopped for futility at the third interim analysis; 90-day global recovery OR 1.03 (0.86-1.25, p = 0.364); no difference in safety variables. Funded by Ferrer Grupo (abstract, PMID 22691567). 10.1016/S0140-6736(12)60813-7
- Lee, G., Choi, S., Chang, J., Choi, D., Son, J. S., Kim, K., Kim, S. M., Jeong, S., & Park, S. M. (2021). Association of L-α glycerylphosphorylcholine with subsequent stroke risk after 10 years. JAMA Network Open, 4(11), e2136008. 10.1001/jamanetworkopen.2021.36008
- Kongkeaw, C., Dilokthornsakul, P., Thanarangsarit, P., Limpeanchob, N., & Norman Scholfield, C. (2014). Meta-analysis of randomized controlled trials on cognitive effects of Bacopa monnieri extract. Journal of Ethnopharmacology, 151(1), 528–535. 9 randomized placebo-controlled trials of standardized extract taken for at least 12 weeks, 518 subjects; pooled analysis of 437: Trail B shortened by 17.9 ms (95% CI -24.6 to -11.2) and choice reaction time by 10.6 ms (-12.1 to -9.2). The authors say only a large head-to-head trial against an existing medication would give definitive data (abstract, PMID 24252493). pubmed.ncbi.nlm.nih.gov/24252493
- Panossian, A., Wikman, G., & Sarris, J. (2010). Rosenroot (Rhodiola rosea): traditional use, chemical composition, pharmacology and clinical efficacy. Phytomedicine, 17(7), 481–493. 10.1016/j.phymed.2010.02.002
- Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of Ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255–262. 64 adults with chronic stress, single-centre, randomized double-blind: 300 mg high-concentration full-spectrum root extract twice daily or placebo for 60 days. Scores on all stress scales fell significantly more than on placebo (P < 0.0001); serum cortisol fell 27.9% from baseline vs 7.9% on placebo, a significant difference; adverse effects were mild and comparable in both groups (abstract, PMID 23439798; full text, PMC3573577). 10.4103/0253-7176.106022
- Livingston, G., Huntley, J., Liu, K. Y., et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572-628. Adds high LDL cholesterol and untreated vision loss for 14 modifiable factors totaling ~45% of dementia risk. 10.1016/S0140-6736(24)01296-0